Healthcare Provider Details

I. General information

NPI: 1659405041
Provider Name (Legal Business Name): BIANCHI OB GYN ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S VINE ST STE A
FALLBROOK CA
92028-2925
US

IV. Provider business mailing address

113 S VINE ST STE A
FALLBROOK CA
92028-2925
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-2313
  • Fax: 760-723-0333
Mailing address:
  • Phone: 760-723-2313
  • Fax: 760-723-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA63365
License Number StateCA

VIII. Authorized Official

Name: ANTHONY STEVEN BIANCHI
Title or Position: OWNER-PHYSICIAN
Credential: M.D.
Phone: 760-723-2313