Provider Demographics
NPI:1386665511
Name:PEDIATRIC CARDIOLOGY MEDICAL ASSOC. OF SO. CALIFORNIA
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY MEDICAL ASSOC. OF SO. CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-784-6269
Mailing Address - Street 1:5400 BALBOA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1529
Mailing Address - Country:US
Mailing Address - Phone:818-784-6269
Mailing Address - Fax:818-784-1531
Practice Address - Street 1:5400 BALBOA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1529
Practice Address - Country:US
Practice Address - Phone:818-784-6269
Practice Address - Fax:818-784-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty