1710200530 NPI number — MICHAEL J. SASEVICH, M.D., A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1710200530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710200530 NPI number — MICHAEL J. SASEVICH, M.D., A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL J. SASEVICH, M.D., A PROFESSIONAL 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710200530
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92038-0600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-632-8400
Provider Business Mailing Address Fax Number:
760-632-8448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 GARDEN VIEW RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-632-8400
Provider Business Practice Location Address Fax Number:
760-632-8448
Provider Enumeration Date:
03/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SASEVICH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT/CARDIOTHORACIC SURGEON
Authorized Official Telephone Number:
760-632-8400

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  A85960 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1629271200 . This is a "PHYSICIAN INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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