Provider Demographics
NPI:1922372663
Name:PEDIATRIC CARDIOLOGISTS OF NORTHERN CALIFORNIA INC
Entity type:Organization
Organization Name:PEDIATRIC CARDIOLOGISTS OF NORTHERN CALIFORNIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:JURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-452-5391
Mailing Address - Street 1:5609 J ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3957
Mailing Address - Country:US
Mailing Address - Phone:916-452-5391
Mailing Address - Fax:916-452-7471
Practice Address - Street 1:5609 J ST
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3957
Practice Address - Country:US
Practice Address - Phone:916-452-5391
Practice Address - Fax:916-452-7471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA364172080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty