Provider Demographics
NPI:1043323991
Name:EAST BAY CARDIOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:EAST BAY CARDIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-233-9323
Mailing Address - Street 1:2101 VALE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3835
Mailing Address - Country:US
Mailing Address - Phone:510-233-9300
Mailing Address - Fax:510-233-9299
Practice Address - Street 1:2101 VALE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3835
Practice Address - Country:US
Practice Address - Phone:510-233-9300
Practice Address - Fax:510-233-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058891Medicaid
CAGR0058891Medicaid