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General NPI Number Information
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NPI Number | 1083625016
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Entity Type | Organization
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Legal Business Name | SAN DIEGO HEART & MEDICAL CLINIC INC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 3660 CLAIREMONT DR STE 6
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City | SAN DIEGO
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State | CA
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Zip | 92117
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Country | US
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Telephone | 858-274-2560
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Fax | 858-274-1610
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Provider Business Mailing Address
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Address Line | 3660 CLAIREMONT DR STE 6
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City | SAN DIEGO
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State | CA
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Zip | 92117
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Country | US
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Telephone | 858-274-2560
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Fax | 858-274-1610
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. JACK J KLEID
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Credential | MD
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Telephone | 858-274-2560
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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 | G20415
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License Number State | CA
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