Provider Demographics
NPI:1730370156
Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP
Entity type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-782-5041
Mailing Address - Street 1:16542 VENTURA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4562
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-1339
Practice Address - Fax:818-898-4301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARDIOVASCULAR CONSULTANTS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2023-01-23
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
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026711Medicaid
CAGR0026710Medicaid
CAW119OtherLEGACY NUMBER
CAGR0026711Medicaid
CAWA60893EMedicare PIN
CAWNP15138CMedicare PIN
CAWG37806GMedicare PIN
CAWG71122CMedicare PIN
CAGR0026710Medicaid
CAWA60872DMedicare PIN
CAWG21218FMedicare PIN
CAW119BMedicare PIN