Provider Demographics
NPI:1023296092
Name:CARDIOLOGY ASSOCIATES MEDICAL GROUP OF EAST SAN DIEGO INC
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES MEDICAL GROUP OF EAST SAN DIEGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY & TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-582-2780
Mailing Address - Street 1:5555 RESERVOIR DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120
Mailing Address - Country:US
Mailing Address - Phone:619-582-2404
Mailing Address - Fax:619-582-2915
Practice Address - Street 1:5555 RESERVOIR DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:619-582-2404
Practice Address - Fax:619-582-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ74366Medicaid
W015Medicare PIN