1144543075 NPI number — CONTEMPORARY MEDICINE A MEDICAL CORPORATION

Table of content: (NPI 1144543075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144543075 NPI number — CONTEMPORARY MEDICINE A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONTEMPORARY MEDICINE A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CONTEMPORARY MEDICINE A MEDICAL CORPORATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144543075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7695 CARDINAL CT
Provider Second Line Business Mailing Address:
SUITE # 375
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-3357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-384-6857
Provider Business Mailing Address Fax Number:
858-277-1475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7695 CARDINAL CT
Provider Second Line Business Practice Location Address:
SUITE # 375
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-384-6857
Provider Business Practice Location Address Fax Number:
858-277-1475
Provider Enumeration Date:
03/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
EVA
Authorized Official Middle Name:
MARIELA
Authorized Official Title or Position:
OFFICE MANAGER/BILLER
Authorized Official Telephone Number:
619-415-6636

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A99956 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A99956 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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