Provider Demographics
NPI:1851318810
Name:CARDIAC IMAGING ASSOCIATES A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CARDIAC IMAGING ASSOCIATES A MEDICAL CORPORATION
Other - Org Name:CARDIAC IMAGING ASSOCIATES A MEDICAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LEWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-655-7610
Mailing Address - Street 1:8581 SANTA MONICA BLVD # 471
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4120
Mailing Address - Country:US
Mailing Address - Phone:323-655-7610
Mailing Address - Fax:
Practice Address - Street 1:8581 SANTA MONICA BLVD # 471
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-4120
Practice Address - Country:US
Practice Address - Phone:323-655-7610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G793250OtherMEDI-CAL PROVIDER #
CA00G793250OtherMEDI-CAL PROVIDER #
G60139Medicare UPIN