Healthcare Provider Details

I. General information

NPI: 1003574203
Provider Name (Legal Business Name): NORTH COUNTY CARDIOVASCULAR SPECIALISTS, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 WARING RD STE 3
OCEANSIDE CA
92056-4454
US

IV. Provider business mailing address

3907 WARING RD STE 3
OCEANSIDE CA
92056-4454
US

V. Phone/Fax

Practice location:
  • Phone: 917-297-4634
  • Fax: 760-450-9655
Mailing address:
  • Phone: 760-224-7766
  • Fax: 760-450-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANITHA RAJAMANICKAM
Title or Position: CEO
Credential: MD
Phone: 917-297-4634