Provider Demographics
NPI:1477591444
Name:STOCKTON CARDIOLOGY MEDICAL GROUP COMPLETE HEART CARE INC
Entity Type:Organization
Organization Name:STOCKTON CARDIOLOGY MEDICAL GROUP COMPLETE HEART CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOTHIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-944-5750
Mailing Address - Street 1:415 E HARDING WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6118
Mailing Address - Country:US
Mailing Address - Phone:209-944-5750
Mailing Address - Fax:
Practice Address - Street 1:415 E HARDING WAY
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6118
Practice Address - Country:US
Practice Address - Phone:209-944-5750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY41622YMedicare ID - Type Unspecified