Healthcare Provider Details

I. General information

NPI: 1588300123
Provider Name (Legal Business Name): HEART AND VASCULAR CENTERS OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49869 CALHOUN ST STE C
COACHELLA CA
92236-9716
US

IV. Provider business mailing address

8787 COMPLEX DR STE 430
SAN DIEGO CA
92123-1453
US

V. Phone/Fax

Practice location:
  • Phone: 760-798-8855
  • Fax:
Mailing address:
  • Phone: 858-302-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SALLEE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 858-302-2502