Healthcare Provider Details

I. General information

NPI: 1780690297
Provider Name (Legal Business Name): BRIDGET CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 2ND ST
ENCINITAS CA
92024-3507
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-7842
  • Fax: 760-753-7259
Mailing address:
  • Phone: 760-736-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA66849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: