1255341814 NPI number — CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION

Table of content: (NPI 1255341814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255341814 NPI number — CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIAC INSTITUTE OF CENTRAL CALIFORNIA A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1255341814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 RIVER PARK PLACE W
Provider Second Line Business Mailing Address:
440
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-256-5500
Provider Business Mailing Address Fax Number:
559-256-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 RIVER PARK PLACE W
Provider Second Line Business Practice Location Address:
440
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-256-5500
Provider Business Practice Location Address Fax Number:
559-256-5505
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORNO
Authorized Official First Name:
SAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
559-256-5500

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0098720 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ29724Z . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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