Provider Demographics
NPI:1144348962
Name:CHULA VISTA INTERNAL MEDICINE & CARDIOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:CHULA VISTA INTERNAL MEDICINE & CARDIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLKINGHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-421-4000
Mailing Address - Street 1:754 MEDICAL CENTER CT
Mailing Address - Street 2:STE 100
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911
Mailing Address - Country:US
Mailing Address - Phone:619-421-4000
Mailing Address - Fax:619-421-6395
Practice Address - Street 1:754 MEDICAL CENTER CT
Practice Address - Street 2:STE 100
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-421-4000
Practice Address - Fax:619-421-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty