Healthcare Provider Details

I. General information

NPI: 1720225808
Provider Name (Legal Business Name): CARDIOVASCULAR CONSULTANTS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6380 CLARK AVE
DUBLIN CA
94568-3036
US

IV. Provider business mailing address

2855 MITCHELL DR STE 223
WALNUT CREEK CA
94598-1609
US

V. Phone/Fax

Practice location:
  • Phone: 925-277-1900
  • Fax: 925-277-1568
Mailing address:
  • Phone: 925-975-5930
  • Fax: 925-975-5941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHELLY WINKLER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 925-975-5944