Provider Demographics
NPI:1578074514
Name:CARDIA SENSE AMC
Entity Type:Organization
Organization Name:CARDIA SENSE AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-434-4288
Mailing Address - Street 1:1415 E 8TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2663
Mailing Address - Country:US
Mailing Address - Phone:619-434-4288
Mailing Address - Fax:619-434-4315
Practice Address - Street 1:1415 E 8TH ST STE 6
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2663
Practice Address - Country:US
Practice Address - Phone:619-434-4288
Practice Address - Fax:619-434-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-17
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124001207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1240010Medicaid
CAA124001Medicaid