Cardiac Molecular Pet Imaging LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

License

NV20161669909 Issued in NV

Legal business name

CARDIAC MOLECULAR PET IMAGING LLC

Practice address

2030 Forest Ave Ste 110
San Jose, CA 95128-4833

Phone

(702) 817-0375

NPI assigned

Jan 15, 2018

Organization subpart

No

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

Authorized official

Name

Mr. James Ballow

Title

Vice President

Phone

(702) 817-0375

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1515974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1629586458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5944 MAHOGANY MOUNTAIN DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891421685",
            "telephone_number": "702-817-0375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 FOREST AVE STE 110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951284833",
            "telephone_number": "702-817-0375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIAC MOLECULAR PET IMAGING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-15",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "BALLOW",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "702-817-0375",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NV",
            "license": "NV20161669909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in San Jose, CA
• Providers in San Jose, CA by specialty
• Physiological Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.