Healthcare Provider Details

I. General information

NPI: 1407956899
Provider Name (Legal Business Name): CALIFORNIA CARDIAC SURGEONS - A MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 SAN DIMAS ST SUITE A-100
BAKERSFIELD CA
93301-2284
US

IV. Provider business mailing address

3838 SAN DIMAS ST SUITE A-100
BAKERSFIELD CA
93301-2284
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-8538
  • Fax: 661-327-5432
Mailing address:
  • Phone: 661-327-8538
  • Fax: 661-327-5432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. VENESSA L GRIFFIN
Title or Position: BUSINESS OFFICE MANAGER
Credential: CPC
Phone: 661-327-8538