Organization Name: | VERSA CARDIO, LLC |
NPI Number: | 1366877508 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARIN SLACK (CEO) |
Mailing Address: | 255 E Rincon St Ste 210 Corona |
State: | CA US |
Postal Code: | 928791368 |
Phone Number: | 8553295794 |
Fax Number: | 8553995796 |
NPI Enumeration Date: | 09/06/2013 |
NPI Last Update Date: | 10/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 293D00000X |
License Number: | 00050469 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Laboratories |
Taxonomy Classification: | Physiological Laboratory |
Taxonomy Specialization: | |
Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |