Provider Demographics
NPI:1912912403
Name:SAN DIEGO ARRHYTHMIA ASSOCIATES, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAN DIEGO ARRHYTHMIA ASSOCIATES, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-0014
Mailing Address - Street 1:501 WASHINGTON ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2231
Mailing Address - Country:US
Mailing Address - Phone:619-297-0014
Mailing Address - Fax:619-297-1014
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:SUITE 512
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-297-0014
Practice Address - Fax:619-297-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84648207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHC150029OtherX-RAY/FLUOROSCOPY
CA00G846480Medicaid
CA00G846480Medicaid
CARHC150029OtherX-RAY/FLUOROSCOPY