Healthcare Provider Details

I. General information

NPI: 1528095049
Provider Name (Legal Business Name): LA JOLLA CARDIOVASCULAR & THORACIC SURGEONS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 560
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

9850 GENESEE AVE SUITE 560
LA JOLLA CA
92037-1224
US

V. Phone/Fax

Practice location:
  • Phone: 858-455-6330
  • Fax: 858-455-5408
Mailing address:
  • Phone: 858-455-6330
  • Fax: 858-455-5408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD LYLE BUEHLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-455-6330