Basic Information
| Provider Information | |||||||||
| NPI: | 1013557636 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JS CARDIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 22336 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921922336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195721961 | ||||||||
| FaxNumber: | 8585468735 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 EL CAJON BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921041005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195434500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2020 | ||||||||
| LastUpdateDate: | 01/11/2020 | ||||||||
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| AuthorizedOfficialLastName: | GROSS | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6195721961 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.