Provider Demographics
NPI:1578615563
Name:SOUTHERN CALIFORNIA CARDIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA CARDIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:PITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-265-1237
Mailing Address - Street 1:6386 ALVARADO CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4906
Mailing Address - Country:US
Mailing Address - Phone:619-265-1237
Mailing Address - Fax:619-265-2142
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4906
Practice Address - Country:US
Practice Address - Phone:619-265-1237
Practice Address - Fax:619-265-2142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016720Medicaid
CAW7956AMedicare ID - Type Unspecified
CAW7956CMedicare ID - Type Unspecified
CAW7956DMedicare ID - Type Unspecified