Provider Demographics
NPI:1265160949
Name:CARDIOLOGY AND VASCULAR CLINIC OF SAN DIEGO, AMC
Entity type:Organization
Organization Name:CARDIOLOGY AND VASCULAR CLINIC OF SAN DIEGO, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-999-1827
Mailing Address - Street 1:591 TELEGRAPH CANYON RD # 766
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6436
Mailing Address - Country:US
Mailing Address - Phone:210-999-1827
Mailing Address - Fax:
Practice Address - Street 1:1415 E 8TH ST STE 7
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2663
Practice Address - Country:US
Practice Address - Phone:619-434-4288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty