Pacific Heart and Vascular Medical Group

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

FNP33233 Issued in CA

Legal business name

PACIFIC HEART AND VASCULAR MEDICAL GROUP

Practice address

55 S Highway 26
Suite 1
Valley Springs, CA 95252-8422

Phone

(877) 835-7938

Fax

(209) 464-1311

NPI assigned

Jun 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michelle Anne Powell

Title

Practice Administrator

Phone

(209) 464-3615

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201046400000",
    "number": "1962439463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 E MARCH LN",
            "address_2": "SUITE D400",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952106629",
            "telephone_number": "209-464-3615",
            "fax_number": "209-464-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 S HIGHWAY 26",
            "address_2": "SUITE 1",
            "city": "VALLEY SPRINGS",
            "state": "CA",
            "postal_code": "952528422",
            "telephone_number": "877-835-7938",
            "fax_number": "209-464-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HEART AND VASCULAR MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2008-01-23",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "209-464-3615",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "FNP33233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0086060",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "ZZZ59842Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael T Peters
• Denise Audrey Mordue-Lain, NP
• Petre P Motiu, M.D.
• Katherine Eileen Murphy
• John Nguyen, PHARM.D.
• Catrina Parsons
• Yesenia F Perez, ASW
• Kim Ngan T Pham, PHARM D
• Stephanie Pollock, M.S., CCC-SLP
• Matthew G Richardson, D.C.

• Cardiovascular Disease Physician in Valley Springs, CA
• Providers in Valley Springs, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.