MEDICARE: SAN DIEGO HEART & MEDICAL CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	G20415	CA

General Provider Information

NPI Number	:	1083625016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO HEART & MEDICAL CLINIC INC

Provider Business Mailing Address
First Line	:	3660 CLAIREMONT DR
Second Line	:	STE 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92117
Country	:	US
Telephone Number	:	858-274-2560
Fax Number	:	858-274-1610

Provider Business Practice Location Address
First Line	:	3660 CLAIREMONT DR
Second Line	:	STE 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92117
Country	:	US
Telephone Number	:	858-274-2560
Fax Number	:	858-274-1610

Authorized Official
Title or Position	:	PHYSICIAN PRESIDENT
Name	:	DR. JACK J KLEID
Credential	:	MD
Telephone Number	:	858-274-2560

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/18/2015

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