Provider Demographics
NPI:1730312638
Name:PACIFIC HEART & VASCULAR MEDICAL GROUP
Entity Type:Organization
Organization Name:PACIFIC HEART & VASCULAR MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STENZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-464-3615
Mailing Address - Street 1:1801 E MARCH LN
Mailing Address - Street 2:STE. D400
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6629
Mailing Address - Country:US
Mailing Address - Phone:877-835-7938
Mailing Address - Fax:209-464-1537
Practice Address - Street 1:15810 S HARLAN RD
Practice Address - Street 2:STE. A
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8719
Practice Address - Country:US
Practice Address - Phone:209-464-3615
Practice Address - Fax:209-464-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09-2629207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty