Provider Demographics
NPI:1194903542
Name:PACIFIC CARDIOVASCULAR, P.S.
Entity type:Organization
Organization Name:PACIFIC CARDIOVASCULAR, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:253-572-4900
Mailing Address - Street 1:PO BOX 64809
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98464-0809
Mailing Address - Country:US
Mailing Address - Phone:253-572-4900
Mailing Address - Fax:253-572-4645
Practice Address - Street 1:1901 S UNION AVE BLDG B
Practice Address - Street 2:SUITE 3001
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1702
Practice Address - Country:US
Practice Address - Phone:253-572-4900
Practice Address - Fax:253-572-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty