Healthcare Provider Details

I. General information

NPI: 1750902326
Provider Name (Legal Business Name): NAD MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/28/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3262 HOLIDAY CT STE 210
LA JOLLA CA
92037-1811
US

IV. Provider business mailing address

444 N EL CAMINO REAL SPC 123
ENCINITAS CA
92024-1317
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-9200
  • Fax: 760-692-4411
Mailing address:
  • Phone: 760-944-9200
  • Fax: 760-692-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP MARK MILGRAM
Title or Position: CEO
Credential: MD
Phone: 858-776-0544