Provider Demographics
NPI:1891786281
Name:NORTHERN CALIFORNIA HEART CARE
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA HEART CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:H
Authorized Official - Last Name:SWOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-927-7894
Mailing Address - Street 1:PO BOX 1410
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4410
Mailing Address - Country:US
Mailing Address - Phone:415-493-3311
Mailing Address - Fax:415-493-3302
Practice Address - Street 1:2 BON AIR RD
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1144
Practice Address - Country:US
Practice Address - Phone:415-927-7894
Practice Address - Fax:415-924-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80799207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28894ZMedicare ID - Type Unspecified
CAZZZ28893ZMedicare PIN