1760438592 NPI number — US HEALTHWORKS MEDICAL GROUP PC

Table of content: (NPI 1760438592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760438592 NPI number — US HEALTHWORKS MEDICAL GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US HEALTHWORKS MEDICAL GROUP PC
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:
6
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:
1760438592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5575 RUFFIN ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-1314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-565-1300
Provider Business Mailing Address Fax Number:
858-565-6932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5611 PALMER WAY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-7242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-603-9166
Provider Business Practice Location Address Fax Number:
760-603-9161
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OKUN
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-565-1300

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ05334Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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