Provider Demographics
NPI:1336531516
Name:INTEGRATIVE CARDIOVASCULAR CENTER OF LA JOLLA
Entity Type:Organization
Organization Name:INTEGRATIVE CARDIOVASCULAR CENTER OF LA JOLLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VITALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AIZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-430-8455
Mailing Address - Street 1:PO BOX 2552
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-2552
Mailing Address - Country:US
Mailing Address - Phone:858-430-8455
Mailing Address - Fax:619-934-3268
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:STE 101
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-430-8455
Practice Address - Fax:619-934-3268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty