Basic Information
| Provider Information | |||||||||
| NPI: | 1285859512 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MISSION HEART & VASCULAR CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3156 VISTA WAY | ||||||||
| Address2: | SUITE 405 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920563622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604396581 | ||||||||
| FaxNumber: | 7604396585 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 BEACH BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906212840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149945290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATTHEWS | ||||||||
| AuthorizedOfficialFirstName: | OSCAR | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7149945290 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 |
No ID Information.