Healthcare Provider Details

I. General information

NPI: 1487842985
Provider Name (Legal Business Name): JMS MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227-B EL CAMINO REAL MISSION DIALYSIS CENTER OF OCEANSIDE
OCEANSIDE CA
92054
US

IV. Provider business mailing address

2227-B EL CAMINO REAL MISSION DIALYSIS CENTER OF OCEANSIDE
OCEANSIDE CA
92054
US

V. Phone/Fax

Practice location:
  • Phone: 760-757-1838
  • Fax: 760-757-6693
Mailing address:
  • Phone: 760-757-1838
  • Fax: 760-757-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA95882
License Number StateCA

VIII. Authorized Official

Name: DR. JILL MARIE MEYER
Title or Position: CEO
Credential: M.D.
Phone: 760-632-5456