Provider Demographics
NPI:1487059960
Name:EVERGREEN CARDIOLOGY GROUP, INC
Entity type:Organization
Organization Name:EVERGREEN CARDIOLOGY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-251-7900
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1590
Mailing Address - Country:US
Mailing Address - Phone:408-251-7900
Mailing Address - Fax:408-258-3100
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 330
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1590
Practice Address - Country:US
Practice Address - Phone:408-251-7900
Practice Address - Fax:408-258-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty