Provider Demographics
NPI:1437323326
Name:CARDIAC IMAGING SERVICES, INC.
Entity type:Organization
Organization Name:CARDIAC IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARDMS, RVT, RDCS
Authorized Official - Phone:661-268-0791
Mailing Address - Street 1:34724 CAPROCK RD
Mailing Address - Street 2:
Mailing Address - City:AGUA DULCE
Mailing Address - State:CA
Mailing Address - Zip Code:91390-5422
Mailing Address - Country:US
Mailing Address - Phone:661-268-0791
Mailing Address - Fax:661-268-0792
Practice Address - Street 1:34724 CAPROCK RD
Practice Address - Street 2:
Practice Address - City:AGUA DULCE
Practice Address - State:CA
Practice Address - Zip Code:91390-5422
Practice Address - Country:US
Practice Address - Phone:661-268-0791
Practice Address - Fax:661-268-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG128Medicare PIN