Healthcare Provider Details

I. General information

NPI: 1427069103
Provider Name (Legal Business Name): SAN DIEGO CARDIOVASCULAR ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR SUITE 204
ENCINITAS CA
92024-5138
US

IV. Provider business mailing address

PO BOX 230757
ENCINITAS CA
92023-0757
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-7300
  • Fax: 760-633-3949
Mailing address:
  • Phone: 760-944-7300
  • Fax: 760-633-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN BACKMAN
Title or Position: OWNER
Credential: M.D.
Phone: 760-944-7300