Provider Demographics
NPI:1033308614
Name:CALIFORNIA CARDIOVASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:CALIFORNIA CARDIOVASCULAR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-351-6363
Mailing Address - Street 1:1532 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1823
Mailing Address - Country:US
Mailing Address - Phone:510-351-6363
Mailing Address - Fax:510-278-3757
Practice Address - Street 1:1532 150TH AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1823
Practice Address - Country:US
Practice Address - Phone:510-351-6363
Practice Address - Fax:510-278-3757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALIFORNIA CARDIOVASCULAR CONSULTANTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-18
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53282207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055252Medicaid