Provider Demographics
NPI:1801299383
Name:CENTRAL CARDIOLOGY MEDICAL CLINIC
Entity type:Organization
Organization Name:CENTRAL CARDIOLOGY MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAMBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-323-8334
Mailing Address - Street 1:3008 SILLECT AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-6340
Mailing Address - Country:US
Mailing Address - Phone:661-616-9300
Mailing Address - Fax:661-616-9301
Practice Address - Street 1:3008 SILLECT AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-6340
Practice Address - Country:US
Practice Address - Phone:661-616-9300
Practice Address - Fax:661-616-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA51933363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty