Provider Demographics
NPI:1376521534
Name:CARDIAC & VASCULAR CARE, INC
Entity Type:Organization
Organization Name:CARDIAC & VASCULAR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MEHRDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REZAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:408-295-2257
Mailing Address - Street 1:2030 FOREST AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4833
Mailing Address - Country:US
Mailing Address - Phone:408-295-2257
Mailing Address - Fax:408-295-2264
Practice Address - Street 1:2030 FOREST AVE
Practice Address - Street 2:STE 210
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4833
Practice Address - Country:US
Practice Address - Phone:408-295-2257
Practice Address - Fax:408-295-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03172ZMedicare ID - Type Unspecified