Healthcare Provider Details

I. General information

NPI: 1144834342
Provider Name (Legal Business Name): SOCAL CARDIOVASCULAR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 E COLORADO BLVD STE 201
PASADENA CA
91107-3849
US

IV. Provider business mailing address

3235 E COLORADO BLVD STE 201
PASADENA CA
91107-3849
US

V. Phone/Fax

Practice location:
  • Phone: 310-896-6474
  • Fax:
Mailing address:
  • Phone: 310-896-6474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DISCEPOLO
Title or Position: PRESIDENT
Credential: MD
Phone: 310-896-6474