MEDICARE: CARDIOVASCULAR CONSULTANTS MEDICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0001X	Clinical Cardiac Electrophysiology Physician
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
3	207RI0011X	Interventional Cardiology Physician
4	207UN0901X	Nuclear Cardiology Physician
5	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	W119C	OTHER	CA	MEDICARE GROUP PROVIDER #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W119	OTHER	CA	LEGACY NUMBER

General Provider Information

NPI Number	:	1689865016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR CONSULTANTS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	16542 VENTURA BLVD STE 402
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4562
Country	:	US
Telephone Number	:	818-782-5041
Fax Number	:	818-205-9091

Provider Business Practice Location Address
First Line	:	23929 MCBEAN PKWY
Second Line	:	SUITE 216
City	:	VALENCIA
State	:	CA
Zip	:	91355-4466
Country	:	US
Telephone Number	:	661-259-1534
Fax Number	:	661-284-3670

Authorized Official
Title or Position	:	PHYSICIAN / MANAGING PARTNER
Name	:	DR. ISAAC WIENER
Credential	:	M.D.
Telephone Number	:	818-782-5041

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	01/23/2023

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