Healthcare Provider Details

I. General information

NPI: 1982221768
Provider Name (Legal Business Name): EQUIP HEALTH MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 STATE ST STE 100
CARLSBAD CA
92008-1627
US

IV. Provider business mailing address

PO BOX 131747
CARLSBAD CA
92013-1747
US

V. Phone/Fax

Practice location:
  • Phone: 855-387-4378
  • Fax: 760-683-6585
Mailing address:
  • Phone: 619-350-6290
  • Fax: 619-436-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CAITLYN DEFIORE
Title or Position: DIRECTOR OF CLIENT OPERATIONS
Credential:
Phone: 508-340-1419