Healthcare Provider Details

I. General information

NPI: 1437121183
Provider Name (Legal Business Name): ESCONDIDO CARDIOLOGY ASSOCIATES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E VALLEY PKWY SUITE 201
ESCONDIDO CA
92025-3363
US

IV. Provider business mailing address

488 E VALLEY PKWY SUITE 201
ESCONDIDO CA
92025-3363
US

V. Phone/Fax

Practice location:
  • Phone: 760-743-0546
  • Fax: 760-743-8837
Mailing address:
  • Phone: 760-743-0546
  • Fax: 760-743-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN H DETWILER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-743-0546