Provider Demographics
NPI:1912114075
Name:CALIFORNIA CARDIOVASCULAR CARE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CALIFORNIA CARDIOVASCULAR CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-657-7172
Mailing Address - Street 1:3235 E COLORADO BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3813
Mailing Address - Country:US
Mailing Address - Phone:626-577-7050
Mailing Address - Fax:626-577-7059
Practice Address - Street 1:3235 E COLORADO BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3813
Practice Address - Country:US
Practice Address - Phone:626-577-7050
Practice Address - Fax:626-577-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53493207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53493OtherSTATE LICENSE
CAH10100Medicare UPIN