Provider Demographics
NPI:1821055054
Name:SOUTHERN CALIFORNIA HEART SPECIALISTS
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEART SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-793-1227
Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3954
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:626-793-3794
Practice Address - Street 1:55 E CALIFORNIA BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3954
Practice Address - Country:US
Practice Address - Phone:626-793-1227
Practice Address - Fax:626-793-3794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP23413207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069260Medicaid
CAGR0069261Medicaid
CACI6769OtherRAIL ROAD MEDICARE
CAZZZ51242ZOtherBLUE SHIELD
CACI2366OtherRAIL ROAD MEDICARE
CAGR0069261Medicaid