Healthcare Provider Details

I. General information

NPI: 1538571864
Provider Name (Legal Business Name): SHEREV HEART AND VASCULAR CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 07/03/2024
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 EL CAJON BLVD STE 100
EL CAJON CA
92020-5760
US

IV. Provider business mailing address

1380 EL CAJON BLVD STE 212
EL CAJON CA
92020-5760
US

V. Phone/Fax

Practice location:
  • Phone: 619-867-0557
  • Fax: 619-867-0558
Mailing address:
  • Phone: 619-867-0557
  • Fax: 619-867-0558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA70917
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA70917
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA70917
License Number StateCA

VIII. Authorized Official

Name: DIMITRI ATANASOV SHEREV
Title or Position: CEO
Credential: MD
Phone: 619-867-0557