Healthcare Provider Details

I. General information

NPI: 1720274400
Provider Name (Legal Business Name): CARDIOVASCULAR INSTITUTE OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43807 10TH ST W STE D
LANCASTER CA
93534-4805
US

IV. Provider business mailing address

43807 N 10TH ST W STE D
LANCASTER CA
93534-4805
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-5500
  • Fax:
Mailing address:
  • Phone: 661-940-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA53800
License Number StateCA

VIII. Authorized Official

Name: KANWALJIT S GILL
Title or Position: PARTNER OWNER
Credential: MD
Phone: 661-940-5500