Healthcare Provider Details

I. General information

NPI: 1245802420
Provider Name (Legal Business Name): SOUTHWEST CARDIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 400
TEMECULA CA
92591-4679
US

IV. Provider business mailing address

1545 W FLORIDA AVE
HEMET CA
92543-3814
US

V. Phone/Fax

Practice location:
  • Phone: 951-693-4433
  • Fax: 951-694-6662
Mailing address:
  • Phone: 951-791-1111
  • Fax: 888-856-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL FOUTZ
Title or Position: CEO, CFO
Credential:
Phone: 951-791-1111