Healthcare Provider Details

I. General information

NPI: 1083848501
Provider Name (Legal Business Name): MGF SURGERY, AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E ELDER ST SUITE 202
FALLBROOK CA
92028-3081
US

IV. Provider business mailing address

521 E ELDER ST SUITE 202
FALLBROOK CA
92028-3081
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-1100
  • Fax: 760-723-2180
Mailing address:
  • Phone: 760-723-1100
  • Fax: 760-723-2180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG46300
License Number StateCA

VIII. Authorized Official

Name: MRS. PAMELA A LEHMAN
Title or Position: BILLING, CREDENTIALING, CONTRACTING
Credential:
Phone: 951-215-1889