Healthcare Provider Details

I. General information

NPI: 1548500192
Provider Name (Legal Business Name): HIGH DESERT CARDIAC & MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17868 US HIGHWAY 18 #102
APPLE VALLEY CA
92307-1267
US

IV. Provider business mailing address

17868 US HIGHWAY 18 #102
APPLE VALLEY CA
92307-1267
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-5177
  • Fax: 760-946-5133
Mailing address:
  • Phone: 760-946-5177
  • Fax: 760-946-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG66022
License Number StateCA

VIII. Authorized Official

Name: DR. SIVA ARUNASALAM
Title or Position: OWNER/ CARDIOLOGIST
Credential: MD
Phone: 760-241-2270