Healthcare Provider Details

I. General information

NPI: 1144049560
Provider Name (Legal Business Name): CALIFORNIA HEART AND VASCULAR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/10/2024
Certification Date: 10/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD STE E1&E2
POWAY CA
92064-2435
US

IV. Provider business mailing address

PO BOX 2575
ALPINE CA
91903-2575
US

V. Phone/Fax

Practice location:
  • Phone: 858-524-6177
  • Fax: 858-524-6195
Mailing address:
  • Phone: 760-353-3222
  • Fax: 760-353-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ATHAR MASOOD ANSARI
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: MD
Phone: 760-353-3222