Healthcare Provider Details

I. General information

NPI: 1013068105
Provider Name (Legal Business Name): NORTH COUNTY ENDOCRINE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 W CITRACADO PKWY SUITE 108
ESCONDIDO CA
92025
US

IV. Provider business mailing address

625 W CITRACADO PKWY SUITE 108
ESCONDIDO CA
92025-6248
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-1431
  • Fax: 760-743-6455
Mailing address:
  • Phone: 760-743-1431
  • Fax: 760-743-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA32416
License Number StateCA

VIII. Authorized Official

Name: MR. TIMOTHY SILLECK BAILEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-743-1431