Provider Demographics
NPI:1134140080
Name:SHIVA HEART CENTER MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SHIVA HEART CENTER MEDICAL GROUP, INC.
Other - Org Name:SHIVA HEART CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-894-7124
Mailing Address - Street 1:36320 INLAND VALLEY DR
Mailing Address - Street 2:#301
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-894-7124
Mailing Address - Fax:951-894-7125
Practice Address - Street 1:36320 INLAND VALLEY DR
Practice Address - Street 2:#301
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-894-7124
Practice Address - Fax:951-894-7125
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JATIN N. AMIN MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-23
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G821180Medicaid
CA00G821180Medicaid