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General NPI Number Information
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NPI Number | 1801082045
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Entity Type | Organization
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Legal Business Name | CALIFORNIA COASTAL CARDIOLOGY,A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/21/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 1235 W VISTA WAY STE L
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City | VISTA
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State | CA
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Zip | 92083-6234
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Country | US
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Telephone | 603-264-0464
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Fax |
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Provider Business Mailing Address
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Address Line | 1235 VISTA WAY, SUITE L
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City | VISTA
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State | CA
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Zip | 92083
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Country | US
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Telephone | 603-264-0464
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. ROBERT W ORR
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Credential | MD
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Telephone | 603-264-0464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A52221
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License Number State | CA
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