Provider Demographics
NPI:1720199797
Name:THE CENTER FOR INTERVENTIONAL CARDIOLOGY & NEPHROLOGY MED GROUP INC
Entity Type:Organization
Organization Name:THE CENTER FOR INTERVENTIONAL CARDIOLOGY & NEPHROLOGY MED GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAKHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:310-652-2744
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:STE# 695W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-652-2744
Mailing Address - Fax:310-967-2140
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:STE# 695W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-652-2744
Practice Address - Fax:310-967-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty