Healthcare Provider Details

I. General information

NPI: 1912912403
Provider Name (Legal Business Name): SAN DIEGO ARRHYTHMIA ASSOCIATES, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST SUITE 512
SAN DIEGO CA
92103-2231
US

IV. Provider business mailing address

501 WASHINGTON ST SUITE 512
SAN DIEGO CA
92103-2231
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-0014
  • Fax: 619-297-1014
Mailing address:
  • Phone: 619-297-0014
  • Fax: 619-297-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG84648
License Number StateCA

VIII. Authorized Official

Name: MANISH KUMAR WADHWA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 619-297-0014