Provider Demographics
NPI:1982288049
Name:CARDIOVASCULAR INTERVENTIONAL SURGERY CENTER
Entity Type:Organization
Organization Name:CARDIOVASCULAR INTERVENTIONAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-290-5322
Mailing Address - Street 1:2621 S BRISTOL ST STE 108B
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5718
Mailing Address - Country:US
Mailing Address - Phone:714-754-1684
Mailing Address - Fax:714-966-0417
Practice Address - Street 1:2621 S BRISTOL ST STE 108B
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5718
Practice Address - Country:US
Practice Address - Phone:714-754-1684
Practice Address - Fax:714-966-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty