Provider Demographics
NPI:1649425307
Name:CALIFORNIA CARDIOVASCULAR SPECIALISTS INC VEIN MEDICAL CLINIC PC
Entity type:Organization
Organization Name:CALIFORNIA CARDIOVASCULAR SPECIALISTS INC VEIN MEDICAL CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SADEGHINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-466-0056
Mailing Address - Street 1:PO BOX 9166
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-9166
Mailing Address - Country:US
Mailing Address - Phone:619-466-0056
Mailing Address - Fax:619-461-0382
Practice Address - Street 1:5358 JACKSON DR
Practice Address - Street 2:STE 1
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3040
Practice Address - Country:US
Practice Address - Phone:619-466-0056
Practice Address - Fax:619-655-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-22
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF388OtherPTAN
AZZ170913Medicare Oscar/Certification