Healthcare Provider Details

I. General information

NPI: 1932254034
Provider Name (Legal Business Name): UNGAB MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 EUCLID AVE SUITE 304
NATIONAL CITY CA
91950-2931
US

IV. Provider business mailing address

502 EUCLID AVE SUITE 304
NATIONAL CITY CA
91950-2931
US

V. Phone/Fax

Practice location:
  • Phone: 619-475-8630
  • Fax: 619-475-8783
Mailing address:
  • Phone: 619-475-8630
  • Fax: 619-475-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA065734
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA065734
License Number StateCA

VIII. Authorized Official

Name: DR. GILANTHONY D UNGAB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-475-8630