MEDICARE: DR. ATHAR MASOOD ANSARI M.D.

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	207RI0011X	Interventional Cardiology Physician	A50706	CA

General Provider Information

NPI Number	:	1477612877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATHAR MASOOD ANSARI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2575
Second Line	:
City	:	ALPINE
State	:	CA
Zip	:	91903-2575
Country	:	US
Telephone Number	:	760-484-3937
Fax Number	:	760-353-3311

Provider Business Practice Location Address
First Line	:	790 W ORANGE AVE
Second Line	:	STE. B
City	:	EL CENTRO
State	:	CA
Zip	:	92243-3274
Country	:	US
Telephone Number	:	760-353-3222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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