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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