Basic Information
| Provider Information | |||||||||
| NPI: | 1730312638 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PACIFIC HEART & VASCULAR MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 E MARCH LN | ||||||||
| Address2: | STE. D400 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952106629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8778357938 | ||||||||
| FaxNumber: | 2094641537 | ||||||||
| Practice Location | |||||||||
| Address1: | 15810 S HARLAN RD | ||||||||
| Address2: | STE. A | ||||||||
| City: | LATHROP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953308719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094643615 | ||||||||
| FaxNumber: | 2094641311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2009 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| AuthorizedOfficialLastName: | STENZLER | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2094643615 | ||||||||
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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 | 09-2629 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.