1982900973 NPI number — MISSION INFECTIOUS DISEASE & INFUSION CONSULTANTS INC

Table of content: (NPI 1982900973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982900973 NPI number — MISSION INFECTIOUS DISEASE & INFUSION CONSULTANTS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION INFECTIOUS DISEASE & INFUSION CONSULTANTS 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:
1982900973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91944-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-464-1165
Provider Business Mailing Address Fax Number:
619-567-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15644 POMERADO RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-312-5459
Provider Business Practice Location Address Fax Number:
858-345-3743
Provider Enumeration Date:
02/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SONI
Authorized Official First Name:
SANDEEP
Authorized Official Middle Name:
ASHU
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
858-312-5459

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A106937 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: A106937 , 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)





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