Healthcare Provider Details

I. General information

NPI: 1790747814
Provider Name (Legal Business Name): ESCONDIDO UROLOGY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S JUNIPER ST
ESCONDIDO CA
92025-4924
US

IV. Provider business mailing address

303 S JUNIPER ST
ESCONDIDO CA
92025-4924
US

V. Phone/Fax

Practice location:
  • Phone: 760-745-7079
  • Fax: 760-745-6199
Mailing address:
  • Phone: 760-745-7079
  • Fax: 760-745-6199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE N RIFFLE
Title or Position: PRESIDENT
Credential: MD
Phone: 760-745-7079