Healthcare Provider Details

I. General information

NPI: 1689829301
Provider Name (Legal Business Name): MARK RECHNIC M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE STE 204
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7300 GIRARD AVE STE 204
LA JOLLA CA
92037-5138
US

V. Phone/Fax

Practice location:
  • Phone: 858-587-9970
  • Fax: 858-587-2867
Mailing address:
  • Phone: 858-587-9970
  • Fax: 858-587-2867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG42815
License Number StateCA

VIII. Authorized Official

Name: DR. MARK RECHNIC
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 858-587-9970