1912029901 NPI number — FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC INC.

Table of content: (NPI 1912029901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912029901 NPI number — FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC 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:
1912029901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11100 WARNER AVENUE
Provider Second Line Business Mailing Address:
SUITE # 268
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-7512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-540-9911
Provider Business Mailing Address Fax Number:
714-549-9720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11100 WARNER AVENUE
Provider Second Line Business Practice Location Address:
SUITE # 268
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-7512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-540-9911
Provider Business Practice Location Address Fax Number:
714-549-9720
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAINATH
Authorized Official First Name:
SHANKARLINGAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-540-9911

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  A25451 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: A31505 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: A25691 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: ZZZ71176Z , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A25691 . This is a "STATE ID SAINATH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: A31505 . This is a "STATE ID MALHOTRA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1366500514 . This is a "INDIVIDUAL NPI MALHOTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1811050081 . This is a "INDIVIDUAL NPI SAINATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: A25451 . This is a "STATE ID SINGH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: WA25691E . This is a "PTAN SAINATH" identifier . This identifiers is of the category "OTHER".
  • Identifier: WA31505B . This is a "PTAN MALHOTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1114085362 . This is a "INDIVIDUAL NPI SINGH" identifier . This identifiers is of the category "OTHER".
  • Identifier: WA25451C . This is a "PTAN SINGH" identifier . This identifiers is of the category "OTHER".




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