Healthcare Provider Details

I. General information

NPI: 1093059776
Provider Name (Legal Business Name): ENCINITAS PALLIATIVE CARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

PO BOX 231189
ENCINITAS CA
92023-1189
US

V. Phone/Fax

Practice location:
  • Phone: 760-230-2251
  • Fax: 760-230-2253
Mailing address:
  • Phone: 760-230-2251
  • Fax: 760-230-2253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD MACCORMICK
Title or Position: OWNER
Credential: M.D.
Phone: 760-230-2251