Provider Demographics
NPI:1396771671
Name:SOUTHBAY CARDIOVASCULAR MEDICAL CENTER, INC
Entity type:Organization
Organization Name:SOUTHBAY CARDIOVASCULAR MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULO
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUILLINTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-427-8646
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-427-8646
Mailing Address - Fax:619-425-7128
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-427-8646
Practice Address - Fax:619-425-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74999OtherMEDICAL LICENSE