Healthcare Provider Details

I. General information

NPI: 1518977958
Provider Name (Legal Business Name): CENTER FOR CARDIOVASCULAR CARE A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JOSE FIGUERES AVE SUITE 325
SAN JOSE CA
95116-1500
US

IV. Provider business mailing address

200 JOSE FIGUERES AVE SUITE 325
SAN JOSE CA
95116-1500
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-9000
  • Fax:
Mailing address:
  • Phone: 408-937-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69198
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA69198
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA69198
License Number StateCA

VIII. Authorized Official

Name: DR. MOHAMMED HABEEB AHMED
Title or Position: PRESIDENT M.D.
Credential: M.D.
Phone: 408-937-9000