Organization
PACIFIC HEART AND VASCULAR MEDICAL GROUP
Active
Organization
PACIFIC HEART AND VASCULAR MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE ANNE POWELL (PRACTICE ADMINISTRATOR)
(209) 464-3615
Entity
Organization
Contact information
Practice address
55 S HIGHWAY 26, SUITE 1, VALLEY SPRINGS, CA 95252-8422
(877) 835-7938
(209) 464-1311
Mailing address
1801 E MARCH LN, SUITE D400, STOCKTON, CA 95210-6629
(209) 464-3615
(209) 464-1311
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
FNP33233
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0086060
—
CA
01
—
ZZZ59842Z
BC BS
CA
Enumeration date
06/28/2006
Last updated
01/23/2008
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