MEDICARE: SAN DIEGO CARDIOVASCULAR ASSOCIATES MEDICAL GROUP 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	163WC3500X	Cardiac Rehabilitation Registered Nurse
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1427069103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO CARDIOVASCULAR ASSOCIATES MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 230757
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92023-0757
Country	:	US
Telephone Number	:	760-944-7300
Fax Number	:	760-633-3949

Provider Business Practice Location Address
First Line	:	320 SANTA FE DR
Second Line	:	SUITE 204
City	:	ENCINITAS
State	:	CA
Zip	:	92024-5138
Country	:	US
Telephone Number	:	760-944-7300
Fax Number	:	760-633-3949

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN BACKMAN
Credential	:	M.D.
Telephone Number	:	760-944-7300

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/19/2023

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