Provider Demographics
NPI:1144834342
Name:SOCAL CARDIOVASCULAR, INC.
Entity type:Organization
Organization Name:SOCAL CARDIOVASCULAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DISCEPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-896-6474
Mailing Address - Street 1:3235 E COLORADO BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-3849
Mailing Address - Country:US
Mailing Address - Phone:310-896-6474
Mailing Address - Fax:
Practice Address - Street 1:3235 E COLORADO BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3849
Practice Address - Country:US
Practice Address - Phone:310-896-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty