1730312638 NPI number — PACIFIC HEART & VASCULAR MEDICAL GROUP

Table of content: (NPI 1730312638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730312638 NPI number — PACIFIC HEART & VASCULAR MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC HEART & VASCULAR MEDICAL GROUP
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:
1730312638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 E MARCH LN
Provider Second Line Business Mailing Address:
STE. D400
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95210-6629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-835-7938
Provider Business Mailing Address Fax Number:
209-464-1537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15810 S HARLAN RD
Provider Second Line Business Practice Location Address:
STE. A
Provider Business Practice Location Address City Name:
LATHROP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95330-8719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-464-3615
Provider Business Practice Location Address Fax Number:
209-464-1311
Provider Enumeration Date:
08/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STENZLER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/PARTNER
Authorized Official Telephone Number:
209-464-3615

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  09-2629 , 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)





Copyright © 2007-2025 www.npivalidator.com