Healthcare Provider Details

I. General information

NPI: 1528120250
Provider Name (Legal Business Name): SAN CARLOS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8881 FLETCHER PKWY SUITE 105
LA MESA CA
91942-3134
US

IV. Provider business mailing address

8881 FLETCHER PKWY SUITE 105
LA MESA CA
91942-3134
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-3311
  • Fax:
Mailing address:
  • Phone: 619-460-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG36980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG62330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG73372
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA73439
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG71174
License Number StateCA

VIII. Authorized Official

Name: DR. WAYNE STEWART TRUE
Title or Position: C.E.O.
Credential: M.D.
Phone: 619-460-3311