Healthcare Provider Details

I. General information

NPI: 1356335731
Provider Name (Legal Business Name): OVIDIU ALB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 4TH AVE STE 202
CHULA VISTA CA
91910-4412
US

IV. Provider business mailing address

480 4TH AVE STE 202
CHULA VISTA CA
91910-4412
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3361
  • Fax: 619-427-6821
Mailing address:
  • Phone: 619-427-3361
  • Fax: 619-427-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC52597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: