Provider Demographics
NPI:1225208168
Name:SOUTHERN CALIFORNIA HEART SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEART SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MAMAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-793-1227
Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3954
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 500
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-294-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFPN23413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ51242ZOtherBLUE SHIELD
CAGR0069260Medicaid
CACI2366OtherRAIL ROAD MEDICARE
CACI6769OtherRAIL ROAD MEDICARE
CAGR0069261Medicaid
CACI6769OtherRAIL ROAD MEDICARE