Organization
OLD PUEBLO CARDIOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEE GOLDBERG (MEDICAL DIRECTOR)
(520) 323-7277
Entity
Organization
Contact information
Practice address
3955 E FORT LOWELL RD, SUITE 113, TUCSON, AZ 85712-1041
(520) 323-7277
(520) 881-1968
Mailing address
PO BOX 64086, TUCSON, AZ 85728-4086
(520) 323-7277
(520) 881-1968
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z119329
PTAN
AZ
Enumeration date
11/21/2007
Last updated
01/20/2012
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