Healthcare Provider Details

I. General information

NPI: 1356569834
Provider Name (Legal Business Name): NORTH COAST FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N. EL CAMINO REAL A306
ENCINITAS CA
92024-1350
US

IV. Provider business mailing address

477 N. EL CAMINO REAL A306
ENCINITAS CA
92024-1350
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-0118
  • Fax: 760-942-5319
Mailing address:
  • Phone: 760-942-0118
  • Fax: 760-942-5319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG50467
License Number StateCA

VIII. Authorized Official

Name: CRAIG S DUCK
Title or Position: CEO
Credential: MD
Phone: 760-942-0118