NPIMap

Organization Active NPI

Icardio Corporation a Medical Corporation

  • Sonography Specialist/Technologist Cardiovascular
  • Los Angeles, CA
National Provider Identifier
1386753515
Registry record updated Jul 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sonography Specialist/Technologist CardiovascularTaxonomy code 246XS1301X
License
G76919 Issued in CA
Legal business name
ICARDIO CORPORATION A MEDICAL CORPORATION
Practice address
1531 Glenville Drive
Los Angeles, CA 90035
Phone
(310) 551-2750
Fax
(310) 861-5620
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua Penn, MD
Title
President
Phone
(310) 551-2750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sonography Specialist/Technologist CardiovascularGroup: 193400000X SINGLE SPECIALTY GROUP 246XS1301X G76919 CA Primary

Addresses

Primary practice location

1531 Glenville Drive
Los Angeles, CA 90035

Mailing address

1531 Glenville Drive
Los Angeles, CA 90035
Phone (310) 551-2750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120620000473 VA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 3072570456 Practice locations: Colonial Heights, VA

National Provider Directory

National Provider Directory

Locations

150 Laguna Rd
Fullerton, CA 92835
Phone (714) 447-0383

11262 Georgia Ave
Wheaton, MD 20902

555 Herndon Pkwy
#100
Herndon, VA 20170
Phone (703) 481-1505

13813 Village Mill Dr
Ste C
Midlothian, VA 23114

7603 Forest Ave
Ste 405
Richmond, VA 23229
Phone (804) 421-7404

1604 Spring Hill Rd
Ste 280A
Vienna, VA 22182

528 Waterloo Rd
Warrenton, VA 20186
Phone (540) 347-0555

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1386753515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 GLENVILLE DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90035",
            "telephone_number": "310-551-2750",
            "fax_number": "310-861-5620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 GLENVILLE DRIVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90035",
            "telephone_number": "310-551-2750",
            "fax_number": "310-861-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARDIO CORPORATION A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "PENN",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-551-2750",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "246XS1301X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist Cardiovascular, Sonography",
            "state": "CA",
            "license": "G76919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.