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General NPI Number Information
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NPI Number | 1902881121
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY MEDICAL GROUP OF SAN GABRIEL VALLEY INC
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 07/13/2010
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Provider Practice Location Address
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Address Line | 625 E BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-2800
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Country | US
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Telephone | 626-915-7300
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Fax | 626-967-8896
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Provider Business Mailing Address
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Address Line | 625 E BADILLO ST
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City | COVINA
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State | CA
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Zip | 91723-2800
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Country | US
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Telephone | 626-915-7300
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Fax | 626-967-8896
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL H MILLER
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Credential | MD
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Telephone | 626-915-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 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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