| Organization Name: | HEALTHCARE MEDICAL GROUP OF LA MESA |
| NPI Number: | 1124165337 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VENU PRABAKER (CEP) |
| Mailing Address: | 7339 El Cajon Blvd Suite I La Mesa |
| State: | CA US |
| Postal Code: | 919413435 |
| Phone Number: | 6196980606 |
| Fax Number: | 6196980609 |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 08/23/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | A42653 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |