Healthcare Provider Details

I. General information

NPI: 1881988814
Provider Name (Legal Business Name): FALLBROOK MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 E ELDER ST SUITE B
FALLBROOK CA
92028-5000
US

IV. Provider business mailing address

593 E ELDER ST SUITE B
FALLBROOK CA
92028-5000
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-5900
  • Fax: 760-723-5906
Mailing address:
  • Phone: 760-723-5900
  • Fax: 760-723-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALVARO BERRIOS
Title or Position: VICE- PRESIDENT
Credential: FNP-C
Phone: 760-723-5900