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General NPI Number Information
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NPI Number | 1063296309
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Entity Type | Organization
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Legal Business Name | SOUTH COAST HEART & VASCULAR A MEDICAL GROUP INC
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 3650 SOUTH ST STE 310
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City | LAKEWOOD
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State | CA
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Zip | 90712-1519
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Country | US
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Telephone | 562-531-1980
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Fax |
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Provider Business Mailing Address
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Address Line | 3650 SOUTH ST STE 310
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City | LAKEWOOD
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State | CA
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Zip | 90712-1519
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Country | US
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Telephone | 562-531-1980
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Fax |
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Authorized Official
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Title or Position | MD
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Name | ISSAC EISENSTEIN
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Credential |
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Telephone | 562-598-9081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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