Provider Demographics
NPI:1558683383
Name:CARDIOCARE LLC
Entity type:Organization
Organization Name:CARDIOCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:951-347-2426
Mailing Address - Street 1:8608 UTICA AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4877
Mailing Address - Country:US
Mailing Address - Phone:951-347-2426
Mailing Address - Fax:
Practice Address - Street 1:8608 UTICA AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4877
Practice Address - Country:US
Practice Address - Phone:951-347-2426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-21
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00020103227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Single Specialty