Healthcare Provider Details

I. General information

NPI: 1275909434
Provider Name (Legal Business Name): TWO ZEDS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 VALLEY CENTRE DR SUITE 702
SAN DIEGO CA
92130-3320
US

IV. Provider business mailing address

3830 VALLEY CENTRE DR SUITE 702
SAN DIEGO CA
92130-3320
US

V. Phone/Fax

Practice location:
  • Phone: 858-720-0554
  • Fax: 858-720-0553
Mailing address:
  • Phone: 858-720-0554
  • Fax: 858-720-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNE JURKOWSKI
Title or Position: CEO
Credential:
Phone: 858-720-0554