Healthcare Provider Details

I. General information

NPI: 1922539865
Provider Name (Legal Business Name): MICHAEL DENNIS HADLEY MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

9909 MIRA MESA BLVD
SAN DIEGO CA
92131-1056
US

V. Phone/Fax

Practice location:
  • Phone: 760-479-3900
  • Fax:
Mailing address:
  • Phone: 858-657-7750
  • Fax: 858-566-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number157438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: