Healthcare Provider Details

I. General information

NPI: 1588850002
Provider Name (Legal Business Name): MADSEN ANDRUS THOMPSON AND SOELBERG PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 12/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 E GRAND AVE
ESCONDIDO CA
92025-3401
US

IV. Provider business mailing address

839 E GRAND AVE
ESCONDIDO CA
92025-3401
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-8888
  • Fax: 760-432-0179
Mailing address:
  • Phone: 760-432-8888
  • Fax: 760-432-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH GOMEZ
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 760-432-8888