MEDICARE: SORRENTO MESA MEDICAL GROUP PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician		CA

General Provider Information

NPI Number	:	1306851266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORRENTO MESA MEDICAL GROUP PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5613 MEADOWS DEL MAR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-4867
Country	:	US
Telephone Number	:	858-455-7657
Fax Number	:	858-455-5014

Provider Business Practice Location Address
First Line	:	5440 MOREHOUSE DR STE 1700
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-6703
Country	:	US
Telephone Number	:	858-455-7657
Fax Number	:	858-455-5014

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BINDU SINGHAL
Credential	:	M.D.
Telephone Number	:	858-455-7657

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/17/2022

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