Healthcare Provider Details

I. General information

NPI: 1609283241
Provider Name (Legal Business Name): CALIFORNIA CARDIOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 05/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31537 RANCHO PUEBLO RD SUITE 204
TEMECULA CA
92592-4857
US

IV. Provider business mailing address

31537 RANCHO PUEBLO RD SUITE 204
TEMECULA CA
92592-4857
US

V. Phone/Fax

Practice location:
  • Phone: 951-302-0888
  • Fax: 951-303-3666
Mailing address:
  • Phone: 951-302-0888
  • Fax: 951-303-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WASEEMUDDIN KAZI
Title or Position: OWNER
Credential: MD
Phone: 951-302-0888