Organization
AMERICAN CARDIO LABS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRAD J. ROELOFS CCT (MANAGER)
(800) 200-4225
Entity
Organization
Contact information
Practice address
17 ELMHURST ST, LADERA RANCH, CA 92694-0850
(800) 200-4225
Mailing address
27702 CROWN VALLEY PKWY # D4-150, LADERA RANCH, CA 92694-0608
(800) 200-4225
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
TG033
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
470000278
RAILROAD MEDICARE
—
01
—
ZZZ42363Z
BLUE SHIELD PROVIDER ID#
CA
Enumeration date
04/02/2007
Last updated
10/13/2010
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