Healthcare Provider Details

I. General information

NPI: 1427084854
Provider Name (Legal Business Name): A. JAMES BEHREND MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STABLERIDGE ST
EL CAJON CA
92019-1245
US

IV. Provider business mailing address

PO BOX 2005
EL CAJON CA
92021-0005
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-5916
  • Fax: 619-334-1313
Mailing address:
  • Phone: 619-462-5916
  • Fax: 619-334-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC40277
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC40277
License Number StateCA

VIII. Authorized Official

Name: ALBERT JAMES BEHREND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-462-5916