Provider Demographics
NPI:1053752915
Name:CALIFORNIA INSTITUTE OF CARDIOVASCULAR HEALTH, INC
Entity type:Organization
Organization Name:CALIFORNIA INSTITUTE OF CARDIOVASCULAR HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AZMOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-466-8810
Mailing Address - Street 1:10535 FOOTHILL BLVD STE 365
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7602
Mailing Address - Country:US
Mailing Address - Phone:909-466-8810
Mailing Address - Fax:909-466-8811
Practice Address - Street 1:10535 FOOTHILL BLVD
Practice Address - Street 2:SUITE #365
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3843
Practice Address - Country:US
Practice Address - Phone:909-466-8810
Practice Address - Fax:909-466-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91785207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty