Provider Demographics
NPI:1427063908
Name:CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:CARDIOVASCULAR MEDICAL GROUP OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SELVYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-278-3400
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:STE 1100
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-278-3400
Mailing Address - Fax:310-278-1240
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:STE 1100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-278-3400
Practice Address - Fax:310-278-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71837ZMedicaid
CAW697CMedicare ID - Type Unspecified
CAW697AMedicare ID - Type Unspecified
CAW697Medicare ID - Type Unspecified
CAHW8157Medicare ID - Type Unspecified
CAZZZ71837ZMedicaid