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General NPI Number Information
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NPI Number | 1538571864
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Entity Type | Organization
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Legal Business Name | SHEREV HEART AND VASCULAR CLINIC, INC.
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 1380 EL CAJON BLVD STE 100
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City | EL CAJON
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State | CA
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Zip | 92020-5760
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Country | US
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Telephone | 619-867-0557
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Fax | 619-867-0558
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Provider Business Mailing Address
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Address Line | 1380 EL CAJON BLVD STE 212
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City | EL CAJON
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State | CA
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Zip | 92020-5760
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Country | US
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Telephone | 619-867-0557
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Fax | 619-867-0558
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Authorized Official
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Title or Position | CEO
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Name | DIMITRI ATANASOV SHEREV
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Credential | MD
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Telephone | 619-867-0557
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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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | A70917
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | A70917
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A70917
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License Number State | CA
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