Organization
PACIFIC COAST CARDIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMANUEL SHAOULIAN M.D. (PARTNER)
(949) 642-5513
Entity
Organization
Contact information
Practice address
3300 W COAST HWY, SUITE A, NEWPORT BEACH, CA 92663-4007
(949) 642-5513
(949) 646-8223
Mailing address
PO BOX 6593, ORANGE, CA 92863-6593
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207U00000X
Nuclear Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI1510
RAILROAD MEDICARE
—
05
—
GR0083980
—
CA
05
—
GR0083981
—
CA
01
—
ZZZ02968Z
BLUE SHIELD OF CA
—
01
—
ZZZ56952Z
BLUE SHIELD OF CA
—
Enumeration date
05/19/2006
Last updated
03/15/2011
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