Basic Information
| Provider Information | |||||||||
| NPI: | 1194750679 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOS ANGELES HEART SPECIALIST MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18370 BURBANK BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189964100 | ||||||||
| FaxNumber: | 8189960842 | ||||||||
| Practice Location | |||||||||
| Address1: | 18370 BURBANK BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189964100 | ||||||||
| FaxNumber: | 8189960842 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | EMRANI | ||||||||
| AuthorizedOfficialFirstName: | AFSHINE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189964100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00G805970 | 05 | CA | MEDICAID | ZZZ06364Z | 01 | CA | BLUE SHIELD | OTHER | P00013000 | 01 | CA | RAILROAD MEDICARE | OTHER |