Healthcare Provider Details

I. General information

NPI: 1679512024
Provider Name (Legal Business Name): ESCONDIDO OB-GYN MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CITRACADO PKWY STE 302
ESCONDIDO CA
92029-4113
US

IV. Provider business mailing address

1955 CITRACADO PKWY STE 302
ESCONDIDO CA
92029-4113
US

V. Phone/Fax

Practice location:
  • Phone: 760-223-1896
  • Fax: 760-233-1899
Mailing address:
  • Phone: 760-233-1896
  • Fax: 760-658-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANISLAV CIZMAR
Title or Position: MANAGING PARTNER
Credential:
Phone: 760-233-1896