Provider Demographics
NPI:1861681355
Name:ST JUDE CARDIOTHORACIC SURGEONS
Entity Type:Organization
Organization Name:ST JUDE CARDIOTHORACIC SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-997-2224
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 503
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-997-2224
Mailing Address - Fax:714-997-1187
Practice Address - Street 1:301 W BASTANCHURY RD
Practice Address - Street 2:SUITE 195
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3419
Practice Address - Country:US
Practice Address - Phone:714-446-8866
Practice Address - Fax:714-997-1187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE COUNTY THORACIC & CARDIOVASCULAR SURGEONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-19
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFNP 36248OtherSTATE OF CA MEDICAL BOARD