Provider Demographics
NPI:1427307230
Name:RELIANCE CARDIAC CARE, INC.
Entity type:Organization
Organization Name:RELIANCE CARDIAC CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-977-0778
Mailing Address - Street 1:333 W GARVEY AVE
Mailing Address - Street 2:# 154-B
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-7430
Mailing Address - Country:US
Mailing Address - Phone:760-277-8888
Mailing Address - Fax:
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 311
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-550-7533
Practice Address - Fax:818-550-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGP873AOtherMEDICARE PTAN #