MEDICARE: PACIFIC RIM ELECTROPHYSIOLOGY MEDICAL GRP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A32891	CA
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	A81336	CA
3	207RC0001X	Clinical Cardiac Electrophysiology Physician	A32891	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407859234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC RIM ELECTROPHYSIOLOGY MEDICAL GRP, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 33679
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-0679
Country	:	US
Telephone Number	:	310-672-9999
Fax Number	:	310-861-0540

Provider Business Practice Location Address
First Line	:	1700 CESAR E. CHAVEZ AVENUE
Second Line	:	SUITE 2700
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2434
Country	:	US
Telephone Number	:	310-672-9999
Fax Number	:	310-861-0540

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	CARLA M DREW
Credential	:
Telephone Number	:	310-672-9999

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/23/2009

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