Healthcare Provider Details

I. General information

NPI: 1437793486
Provider Name (Legal Business Name): HEALTHY HEARTS MEDICAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2019
Last Update Date: 11/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 OTAY LAKES RD STE 502121
CHULA VISTA CA
91915-1004
US

IV. Provider business mailing address

PO BOX 213093
CHULA VISTA CA
91921-3093
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-5163
  • Fax: 888-316-1604
Mailing address:
  • Phone: 888-417-5163
  • Fax: 888-316-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN MILLER
Title or Position: DIRECTOR
Credential:
Phone: 888-417-5163