Provider Demographics
NPI:1255341814
Name:CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:BORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-256-5500
Mailing Address - Street 1:30 RIVER PARK PLACE W
Mailing Address - Street 2:440
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-256-5500
Mailing Address - Fax:559-256-5505
Practice Address - Street 1:30 RIVER PARK PLACE W
Practice Address - Street 2:440
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-256-5500
Practice Address - Fax:559-256-5505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0098720Medicaid
ZZZ29724ZOtherMEDICARE PTAN
ZZZ29724ZOtherMEDICARE PTAN