Organization Name: | LAS PALMAS MEDICAL GROUP |
NPI Number: | 1063718930 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARLOS MENA (OFFICE MANAGER) |
Mailing Address: | 1540 E Valley Pkwy Escondido |
State: | CA US |
Postal Code: | 920272316 |
Phone Number: | 7606214902 |
Fax Number: | 7604000012 |
NPI Enumeration Date: | 02/09/2011 |
NPI Last Update Date: | 02/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G57022 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |