=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891860375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIOLOGY ASSOCIATES OF NORTH CTY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 161 THUNDER DRIVE #104
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-941-6664
-----------------------------------------------------
Fax | 760-941-3257
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 161 THUNDER DRIVE #104
-----------------------------------------------------
City | VISTA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92083-6051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-941-6664
-----------------------------------------------------
Fax | 760-941-3257
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. EDWARD BARTON EVANS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 760-941-6664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | G43785
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------