1477513240 NPI number — CARDIOVASCULAR ASSOCIATES OF THE PENINSULA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477513240 NPI number — CARDIOVASCULAR ASSOCIATES OF THE PENINSULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR ASSOCIATES OF THE PENINSULA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477513240
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 EL CAMINO REAL
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-3224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-259-5300
Provider Business Mailing Address Fax Number:
650-259-5390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-259-5300
Provider Business Practice Location Address Fax Number:
650-259-5390
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
HARRIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
650-259-5300

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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