Provider Demographics
NPI:1851443717
Name:ANTONY C ERNEST MD INC ARUN N MEHTA MD PROF CORP ET AL PTR VALLEY CARD
Entity Type:Organization
Organization Name:ANTONY C ERNEST MD INC ARUN N MEHTA MD PROF CORP ET AL PTR VALLEY CARD
Other - Org Name:VALLEY CARDIOLOGY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:READER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-948-2621
Mailing Address - Street 1:PO BOX 6110
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-6110
Mailing Address - Country:US
Mailing Address - Phone:661-948-2621
Mailing Address - Fax:661-948-1632
Practice Address - Street 1:43839 15TH ST W
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4756
Practice Address - Country:US
Practice Address - Phone:661-948-2621
Practice Address - Fax:661-948-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31133207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0001610Medicaid
CADA1141OtherRRM GROUP
CADA1141OtherRRM GROUP
CAGR0001610Medicaid