Provider Demographics
NPI:1407859234
Name:PACIFIC RIM ELECTROPHYSIOLOGY MEDICAL GRP, INC.
Entity Type:Organization
Organization Name:PACIFIC RIM ELECTROPHYSIOLOGY MEDICAL GRP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-672-9999
Mailing Address - Street 1:P.O. BOX 33679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-0679
Mailing Address - Country:US
Mailing Address - Phone:310-672-9999
Mailing Address - Fax:310-861-0540
Practice Address - Street 1:1700 CESAR E. CHAVEZ AVENUE
Practice Address - Street 2:SUITE 2700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2434
Practice Address - Country:US
Practice Address - Phone:310-672-9999
Practice Address - Fax:310-861-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32891174400000X, 207RC0001X
CAA81336207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090210Medicaid
CAA84402Medicare UPIN