Organization · NPI-2

Advanced MD Medical Group INC

General Practice · San Diego, CA

NPI number1780128256
StatusActive
Last updated in NPPESDec 18, 2016

Details

NPI
1780128256
Entity type
Organization (NPI-2)
Legal business name
Advanced MD Medical Group INC
Organization subpart
No
Enumeration date
Dec 18, 2016
Last updated
Dec 18, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General PracticeG87969CAYes

Practice location

2878 Camino Del Rio S Ste 404
San Diego, CA 92108-3848

Phone 858-345-4887

Mailing address

235 W Washington Ave
A55
Escondido, CA 92025-2634

Phone 858-345-4887

Authorized official

Dirk Kancilia
Administration
8583454887

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