Provider Demographics
NPI:1659498004
Name:BOYLE HEIGHTS CARDIOVASCULAR MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BOYLE HEIGHTS CARDIOVASCULAR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRANG
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-350-1555
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2467
Mailing Address - Country:US
Mailing Address - Phone:323-268-2200
Mailing Address - Fax:323-268-2212
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 1200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2467
Practice Address - Country:US
Practice Address - Phone:323-268-2200
Practice Address - Fax:323-268-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA069594207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty