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General NPI Number Information
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NPI Number | 1790195410
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CONSULTANTS MEDICAL GROUP
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 16542 VENTURA BLVD SUITE 402
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City | ENCINO
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State | CA
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Zip | 91436-2005
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Country | US
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Telephone | 818-782-5041
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Fax | 818-782-4864
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Provider Business Mailing Address
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Address Line | 16542 VENTURA BLVD STE 402
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City | ENCINO
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State | CA
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Zip | 91436-4562
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Country | US
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Telephone | 818-782-5041
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Fax | 818-205-9091
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | ISAAC WIENER
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Credential | MD
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Telephone | 818-782-5041
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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 |
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License Number State |
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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 |
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License Number State |
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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 |
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License Number State |
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