Healthcare Provider Details

I. General information

NPI: 1154004497
Provider Name (Legal Business Name): SD PREMIER CARDIAC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 EUCLID AVE STE 301
NATIONAL CITY CA
91950-2972
US

IV. Provider business mailing address

PO BOX 882201
SAN DIEGO CA
92168-2201
US

V. Phone/Fax

Practice location:
  • Phone: 619-472-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PRASHANT H PATEL
Title or Position: CEO
Credential:
Phone: 619-472-4900