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General NPI Number Information
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NPI Number | 1912029901
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VALLEY CARDIOLOGY MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | 11100 WARNER AVENUE SUITE # 268
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7512
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Country | US
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Telephone | 714-540-9911
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Fax | 714-549-9720
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Provider Business Mailing Address
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Address Line | 11100 WARNER AVENUE SUITE # 268
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7512
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Country | US
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Telephone | 714-540-9911
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Fax | 714-549-9720
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHANKARLINGAM SAINATH
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Credential | M.D.
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Telephone | 714-540-9911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A31505
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A25691
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A25451
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License Number State | CA
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