Basic Information
| Provider Information | |||||||||
| NPI: | 1033174552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED CARDIOVASCULAR INTERPRETATIONS MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2311 | ||||||||
| Address2: | |||||||||
| City: | CHATSWORTH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913132311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185015686 | ||||||||
| FaxNumber: | 8055788950 | ||||||||
| Practice Location | |||||||||
| Address1: | 15031 RINALDI ST | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188984603 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHIENER | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8185015686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALAN SHIENER MD INC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | GR0088311 | 05 | CA | MEDICAID |