Provider Demographics
NPI:1376582759
Name:CARDIOLOGY CONSULTANTS MEDICAL GROUP OF THE VALLEY INC.
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS MEDICAL GROUP OF THE VALLEY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DES BAILLETS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-5580
Mailing Address - Street 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE 707
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2804
Mailing Address - Country:US
Mailing Address - Phone:818-345-5580
Mailing Address - Fax:818-345-5876
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 707
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-345-5580
Practice Address - Fax:818-345-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1376582759OtherANTHEM BLUE CROSS