Healthcare Provider Details

I. General information

NPI: 1285976787
Provider Name (Legal Business Name): OUTREACH CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 S EL CAMINO REAL SUITE 104
OCEANSIDE CA
92054-6229
US

IV. Provider business mailing address

2171 S EL CAMINO REAL SUITE 104
OCEANSIDE CA
92054-6229
US

V. Phone/Fax

Practice location:
  • Phone: 760-754-5663
  • Fax:
Mailing address:
  • Phone: 760-754-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA60865
License Number StateCA

VIII. Authorized Official

Name: DR. JACOB N FLORES
Title or Position: PHYSICIAN
Credential:
Phone: 760-754-5663