Healthcare Provider Details

I. General information

NPI: 1760634364
Provider Name (Legal Business Name): JOHN M KROENER A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY SUITE 200
OCEANSIDE CA
92056-4500
US

IV. Provider business mailing address

3998 VISTA WAY SUITE 200
OCEANSIDE CA
92056-4500
US

V. Phone/Fax

Practice location:
  • Phone: 760-724-5352
  • Fax: 760-724-5447
Mailing address:
  • Phone: 760-724-5352
  • Fax: 760-724-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG35262
License Number StateCA

VIII. Authorized Official

Name: JOHN M. KROENER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-724-5352