Provider Demographics
NPI:1154397628
Name:FULLERTON CARDIOVASCULAR MED GROUP, INC
Entity type:Organization
Organization Name:FULLERTON CARDIOVASCULAR MED GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-870-4665
Mailing Address - Street 1:2240 N HARBOR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2635
Mailing Address - Country:US
Mailing Address - Phone:714-870-2084
Mailing Address - Fax:714-870-2085
Practice Address - Street 1:2240 N HARBOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2635
Practice Address - Country:US
Practice Address - Phone:714-870-2084
Practice Address - Fax:714-870-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty