Provider Demographics
NPI:1407956899
Name:CALIFORNIA CARDIAC SURGEONS - A MEDICAL GROUP
Entity Type:Organization
Organization Name:CALIFORNIA CARDIAC SURGEONS - A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VENESSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:661-327-8538
Mailing Address - Street 1:3838 SAN DIMAS ST
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2284
Mailing Address - Country:US
Mailing Address - Phone:661-327-8538
Mailing Address - Fax:661-327-5432
Practice Address - Street 1:3838 SAN DIMAS ST
Practice Address - Street 2:SUITE A-100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2284
Practice Address - Country:US
Practice Address - Phone:661-327-8538
Practice Address - Fax:661-327-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ42099ZOtherBLUE SHIELD GROUP ID
CAGR0060120Medicaid
ZZZ42099ZOtherBLUE SHIELD GROUP ID