Provider Demographics
NPI:1902062789
Name:CIRCULATION TESTING FACILITY LLC
Entity Type:Organization
Organization Name:CIRCULATION TESTING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, RVS
Authorized Official - Phone:915-820-4190
Mailing Address - Street 1:530 SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-5216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10470 VISTA DEL SOL DR
Practice Address - Street 2:STE 109
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7948
Practice Address - Country:US
Practice Address - Phone:915-629-0522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
38088OtherARDMS REGISTRY
00030011OtherCARDIOVASCULAR CREDENTIALING INTERNATIONAL REG. ID
TX088028801Medicaid
00030011OtherCARDIOVASCULAR CREDENTIALING INTERNATIONAL REG. ID