Provider Demographics
NPI:1205881521
Name:CARDIOVASCULAR CONSULTANTS OF SAN GABRIEL VALLEY, INC.
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF SAN GABRIEL VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-566-2750
Mailing Address - Street 1:900 S 1ST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7527
Mailing Address - Country:US
Mailing Address - Phone:626-566-2750
Mailing Address - Fax:626-566-2756
Practice Address - Street 1:900 S 1ST AVE
Practice Address - Street 2:STE C
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7527
Practice Address - Country:US
Practice Address - Phone:626-566-2750
Practice Address - Fax:626-566-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19755OtherMEDICARE
CAZZZ66477ZOtherBLUE SHIELD
CAGR0102190Medicaid