Provider Demographics
NPI:1366544025
Name:NATIONWIDE CARDIO
Entity type:Organization
Organization Name:NATIONWIDE CARDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:IDTF
Authorized Official - Phone:951-776-7314
Mailing Address - Street 1:16400 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5724
Mailing Address - Country:US
Mailing Address - Phone:888-252-9700
Mailing Address - Fax:
Practice Address - Street 1:16400 LOIS LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-5724
Practice Address - Country:US
Practice Address - Phone:951-776-7314
Practice Address - Fax:855-399-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00050469293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25676ZMedicare ID - Type UnspecifiedIDTF