Provider Demographics
NPI:1518311687
Name:CARDIOVASCULAR SPECIALIST PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-401-9697
Mailing Address - Street 1:PO BOX 9166
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-9166
Mailing Address - Country:US
Mailing Address - Phone:928-344-3968
Mailing Address - Fax:
Practice Address - Street 1:2281 W 24TH ST
Practice Address - Street 2:STE 12
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6154
Practice Address - Country:US
Practice Address - Phone:928-344-3968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47230207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty