Provider Demographics
NPI:1619028149
Name:SANTA CLARITA CARDIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SANTA CLARITA CARDIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ETON
Authorized Official - Last Name:QUAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-255-8321
Mailing Address - Street 1:23928 LYONS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2452
Mailing Address - Country:US
Mailing Address - Phone:661-255-8321
Mailing Address - Fax:661-255-0338
Practice Address - Street 1:23928 LYONS AVE STE 101
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2452
Practice Address - Country:US
Practice Address - Phone:661-255-8321
Practice Address - Fax:661-255-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACORP#2878253207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ576762OtherBLUE SHIELD
BU572AMedicare PIN