1427099720 NPI number — GROSSMONT FAMILY MEDICAL GROUP, INC.

Table of content: (NPI 1427099720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427099720 NPI number — GROSSMONT FAMILY MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GROSSMONT FAMILY MEDICAL GROUP, INC.
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:
Provider Other Organization Name Type Code:
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:
1427099720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5525 GROSSMONT CENTER DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-644-6500
Provider Business Mailing Address Fax Number:
619-644-6526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5525 GROSSMONT CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91942-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-644-6500
Provider Business Practice Location Address Fax Number:
619-644-6526
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEONARD
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
619-644-6500

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: GR0086840 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com