Healthcare Provider Details

I. General information

NPI: 1174565584
Provider Name (Legal Business Name): CARDIAC SURGERY WEST MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 J ST SUITE 270
SACRAMENTO CA
95819-3628
US

IV. Provider business mailing address

3941 J ST SUITE 270
SACRAMENTO CA
95819-3628
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-6850
  • Fax: 916-733-6824
Mailing address:
  • Phone: 916-733-6850
  • Fax: 916-733-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number97989
License Number StateCA

VIII. Authorized Official

Name: ALLEN S MORRIS
Title or Position: SECRETARY/TREASURER
Credential: M.D.
Phone: 916-733-6850