Basic Information
| Provider Information | |||||||||
| NPI: | 1033415385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN CALIFORNIA CARDIOVASCULAR INSTITUTE APC | ||||||||
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| OtherOrganizationName: | CALIFORNIA CARDIOVASCULAR INSTITUTE APC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132231100 | ||||||||
| FaxNumber: | 2132231104 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2011 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2132231100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.