Healthcare Provider Details

I. General information

NPI: 1164483723
Provider Name (Legal Business Name): WARING COURT PEDIATRIC AND ADULT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT SUITE J
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

3230 WARING CT STE J
OCEANSIDE CA
92056-4509
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-4498
  • Fax: 760-941-6938
Mailing address:
  • Phone: 760-941-4498
  • Fax: 760-941-6938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19297
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberPA15228
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA113589
License Number StateCA

VIII. Authorized Official

Name: EVANNE WILKEY
Title or Position: PRACTICE DIRECTOR
Credential:
Phone: 760-941-4498