Provider Demographics
NPI:1912029901
Name:FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANKARLINGAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-540-9911
Mailing Address - Street 1:11100 WARNER AVENUE
Mailing Address - Street 2:SUITE # 268
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7512
Mailing Address - Country:US
Mailing Address - Phone:714-540-9911
Mailing Address - Fax:714-549-9720
Practice Address - Street 1:11100 WARNER AVENUE
Practice Address - Street 2:SUITE # 268
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7512
Practice Address - Country:US
Practice Address - Phone:714-540-9911
Practice Address - Fax:714-549-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25451207RC0000X
CAA31505207RC0000X
CAA25691207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71176ZMedicaid
CAA25691OtherSTATE ID SAINATH
CAA31505OtherSTATE ID MALHOTRA
1366500514OtherINDIVIDUAL NPI MALHOTRA
1811050081OtherINDIVIDUAL NPI SAINATH
CAA25451OtherSTATE ID SINGH
WA25691EOtherPTAN SAINATH
WA31505BOtherPTAN MALHOTRA
1114085362OtherINDIVIDUAL NPI SINGH
WA25451COtherPTAN SINGH
CAZZZ71176ZMedicaid