1487059960 NPI number — EVERGREEN CARDIOLOGY GROUP, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487059960 NPI number — EVERGREEN CARDIOLOGY GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERGREEN CARDIOLOGY GROUP, INC
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487059960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 JOSE FIGUERES AVE STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95116-1590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-251-7900
Provider Business Mailing Address Fax Number:
408-258-3100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 JOSE FIGUERES AVE STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-251-7900
Provider Business Practice Location Address Fax Number:
408-258-3100
Provider Enumeration Date:
10/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MA
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
408-251-7900

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)





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