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General NPI Number Information
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NPI Number | 1336531516
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CARDIOVASCULAR CENTER OF LA JOLLA
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 03/17/2015
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Provider Practice Location Address
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Address Line | 9834 GENESEE AVE STE 101
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City | LA JOLLA
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State | CA
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Zip | 92037-1223
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Country | US
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Telephone | 858-430-8455
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Fax | 619-934-3268
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Provider Business Mailing Address
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Address Line | PO BOX 2552
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City | CHULA VISTA
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State | CA
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Zip | 91912-2552
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Country | US
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Telephone | 858-430-8455
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Fax | 619-934-3268
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Authorized Official
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Title or Position | MD
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Name | VITALI AIZIN
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Credential |
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Telephone | 858-430-8455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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