Healthcare Provider Details

I. General information

NPI: 1154861979
Provider Name (Legal Business Name): ELIZABETH SUPPORTIVE MEDICAL SPECIALISTS, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W VALLEY PKWY STE 203
ESCONDIDO CA
92025-2557
US

IV. Provider business mailing address

800 W VALLEY PKWY STE 100
ESCONDIDO CA
92025-2557
US

V. Phone/Fax

Practice location:
  • Phone: 760-796-3763
  • Fax: 760-796-3788
Mailing address:
  • Phone: 760-737-2050
  • Fax: 760-796-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES F VON GUNTEN
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 760-737-2050