Provider Demographics
NPI:1295765428
Name:CARDIOVASCULAR CONSULTANTS OF THE INLAND VALLEY
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS OF THE INLAND VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-601-2363
Mailing Address - Street 1:12810 HEACOCK ST
Mailing Address - Street 2:SUITE B201
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-2854
Mailing Address - Country:US
Mailing Address - Phone:951-601-2363
Mailing Address - Fax:951-601-2316
Practice Address - Street 1:12810 HEACOCK ST
Practice Address - Street 2:SUITE B201
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-2854
Practice Address - Country:US
Practice Address - Phone:951-601-2363
Practice Address - Fax:951-601-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071570Medicaid
CAGR0071570Medicaid