Provider Demographics
NPI:1366562571
Name:SACRED HEART DIAGNOSTICS CENTER, INCORPORATED
Entity type:Organization
Organization Name:SACRED HEART DIAGNOSTICS CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA TERESA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARANDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-524-1186
Mailing Address - Street 1:4440 E WASHINGTON AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5792
Mailing Address - Country:US
Mailing Address - Phone:702-524-1186
Mailing Address - Fax:702-341-0638
Practice Address - Street 1:4440 E WASHINGTON AVE
Practice Address - Street 2:STE 109
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5792
Practice Address - Country:US
Practice Address - Phone:702-524-1186
Practice Address - Fax:702-341-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV265154OtherBUSINESS LICENSE