Organization
CARDIOLOGY PRACTICE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD FERNANDO PEGO M.D. (PRESIDENT)
(818) 365-9595
Entity
Organization
Contact information
Practice address
17075 DEVONSHIRE ST STE 201, NORTHRIDGE, CA 91325-5407
(818) 365-9595
(818) 365-8955
Mailing address
17075 DEVONSHIRE ST STE 201, NORTHRIDGE, CA 91325-5407
(818) 365-9595
(818) 365-8955
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A33230
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060067979
MEDICARE RAILROAD
CA
01
—
222031992
BLUE SHIELD
CA
05
—
GR0091580
—
CA
Enumeration date
12/22/2006
Last updated
06/15/2010
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