PACIFIC HEART AND VASCULAR MEDICAL GROUP (NPI# 1649208463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649208463 |
| Entity Type | Organization |
| Organization Name | PACIFIC HEART AND VASCULAR MEDICAL GROUP |
| Practice Address |
1801 E March Lane Suite D400 Stockton CA 95210-5667 |
| Practice Telephone | 2094643615 |
| Practice Fax Number | 2094641311 |
| Mailing Telephone | 2094643615 |
| Mailing Fax Number | 2094641311 |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-03-02 |
| Authorized Official Name | KATHERINE BOHNA (SUPERVISOR) |
| Authorized Official Telephone | 2094643615 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
FNP33233 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BC/BS GROUP PROVIDER # | ZZZ59840Z | 01 |
| CA | RAILROAD MEDICARE GROUP # | 060057321 | 01 |
| CA | GR0086062 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962439463 | Pacific Heart and Vascular Medical Group | Internal Medicine | 55 S Highway 26, Suite 1, Valley Springs, CA 95252-8422 | 2006-06-28 |
| 1790712990 | Pacific Heart and Vascular Medical Group | Internal Medicine | 845 S Fairmont Ave, Suite 11, Lodi, CA 95240-5113 | 2006-06-26 |
| Street Address |
1801 E MARCH LANE SUITE D400 |
| City | STOCKTON |
| State | CA |
| Zip Code | 95210-5667 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720148612 | Sanjeev Kumar Goswami | Internal Medicine | 1801 E March Lane, Stockton, Stockton, CA 95210-6676 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021970 | Leslie Jazmin Marin | Student in an Organized Health Care Education/Training Program | 7109 Danny Dr, Stockton, Stockton, CA 95210 | 2020-07-27 |
| 1043866692 | Alexis Thomasson | Behavior Technician | 7109 Danny Drive, Stockton, CA 95210 | 2019-08-09 |
| 1821651324 | Maria Guadalupe Toledo | Lactation Consultant, Non-RN | 7912 Hammer Lane, Stockton, CA 95210 | 2019-04-19 |
| 1508226440 | Active Life Adult Day Care, Inc. | Clinic/Center | 7209 Tam O'shanter Dr., Stockton, CA 95210 | 2016-03-04 |
| 1548631260 | Rachel Standley | Substance Abuse Rehabilitation Facility | 8017 El Cajon St, Stockton, CA 95210 | 2015-10-08 |
| 1225435308 | Active Life Medical Produtcs Inc | Durable Medical Equipment & Medical Supplies | 611 W Grider Way, Stockton, CA 95210 | 2014-12-04 |
| 1942633318 | Kimberly Ruiz Dizon | Physician Assistant | 1530 E Hammer Ln, Stockton, CA 95210 | 2013-08-20 |
| 1285920983 | Supplemental Health Care | Preferred Provider Organization | 8425 Kiltie Wy, Stockton, CA 95210 | 2011-06-22 |
| 1770807901 | Stockton Medical Weight Loss Center Inc | Internal Medicine | 1801 E. March Lane, Suite 400d, Stockton, CA 95210 | 2010-03-17 |
| 1699911412 | Pratap Krishna Anne | Pharmacist | 1801 E.march Ln, Suite:b280, Bjrx, Stockton, CA 95210 | 2008-12-29 |
| Find all providers in zip 95210 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376665703 | M. Thabet Karabala, M.d., Inc. | Internal Medicine | 940 N Center St Ste A, Stockton, CA 95202-1326 | 2007-04-05 |
| 1609826288 | M Thabet Karabala | Internal Medicine | 940 N Center St, Ste A, Stockton, CA 95202-1326 | 2006-05-12 |
| 1538783519 | Brooke Nicole Fletcher | Internal Medicine | 2633 Pacific Ave, Stockton, CA 95204-4429 | 2020-06-04 |
| 1962715987 | Muhammad W Choudhry | Internal Medicine | 2333 N California St, Stockton, CA 95204-5530 | 2010-07-19 |
| 1114157484 | Manreet Basra | Internal Medicine | 1801 E March Ln Ste D400, Stockton, CA 95210-6675 | 2009-07-21 |
| 1700035334 | Masanobu Kamigaki | Internal Medicine | 415 E Harding Way, Suite D, Stockton, CA 95204-6118 | 2008-09-18 |
| 1013030006 | Delta Heart & Medical Clinic, Inc. | Internal Medicine | 1801 E March Ln, A-170, Stockton, CA 95210-6629 | 2007-04-06 |
| 1093832636 | Amit Parekh | Internal Medicine | 7373 West Lane, Stockton, CA 95210 | 2007-03-26 |
| 1255481057 | Salma A. Baber | Internal Medicine | 7373 West Ln, Stockton, CA 95210-3377 | 2007-01-12 |
| 1578641478 | Ravindra Sharma | Internal Medicine | 7373 West Ln, Stockton, CA 95210-3377 | 2006-11-01 |
| Find all providers in STOCKTON | ||||
Please comment or provide details below to improve the information on PACIFIC HEART AND VASCULAR MEDICAL GROUP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.