Healthcare Provider Details

I. General information

NPI: 1013366236
Provider Name (Legal Business Name): HEALTH LINK MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY STE 206
OCEANSIDE CA
92056-3619
US

IV. Provider business mailing address

3142 VISTA WAY STE 206
OCEANSIDE CA
92056-3619
US

V. Phone/Fax

Practice location:
  • Phone: 760-721-4000
  • Fax: 760-721-4005
Mailing address:
  • Phone: 760-721-4000
  • Fax: 760-721-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA60865
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20A13788
License Number StateCA

VIII. Authorized Official

Name: JACOB FLORES
Title or Position: OWNER
Credential: MD
Phone: 760-809-4045