Provider Demographics
NPI:1053435248
Name:CALIFORNIA CARDIOVASCULAR CONSULTANT MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:CALIFORNIA CARDIOVASCULAR CONSULTANT MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:HLA
Authorized Official - Last Name:MYINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-796-0222
Mailing Address - Street 1:4262 CENTRAL AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4985
Mailing Address - Country:US
Mailing Address - Phone:510-229-7824
Mailing Address - Fax:
Practice Address - Street 1:1900 MOWRY AVE STE 309
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-796-0222
Practice Address - Fax:510-796-7760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96837261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center