Provider Demographics
NPI:1447262340
Name:SOUTHWEST HEART INSTITUTE MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOUTHWEST HEART INSTITUTE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-693-4433
Mailing Address - Street 1:PO BOX 891022
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-1022
Mailing Address - Country:US
Mailing Address - Phone:951-693-4433
Mailing Address - Fax:951-303-6432
Practice Address - Street 1:31720 TEMECULA PKWY
Practice Address - Street 2:100
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5895
Practice Address - Country:US
Practice Address - Phone:951-693-4433
Practice Address - Fax:951-303-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32208207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN