Provider Demographics
NPI:1942457130
Name:SAN DIEGO CARDIOVASCULAR IMAGING SERVICES, INC.
Entity Type:Organization
Organization Name:SAN DIEGO CARDIOVASCULAR IMAGING SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-616-2100
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:#204
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6654
Mailing Address - Country:US
Mailing Address - Phone:619-616-2100
Mailing Address - Fax:619-616-2104
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:#204
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6654
Practice Address - Country:US
Practice Address - Phone:619-616-2100
Practice Address - Fax:619-616-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7241246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Multi-Specialty