Healthcare Provider Details

I. General information

NPI: 1356251474
Provider Name (Legal Business Name): D. G. FUNSCH MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W BROADWAY STE 700 OFFICE 112
SAN DIEGO CA
92101
US

IV. Provider business mailing address

600 W BROADWAY STE 700 OFFICE 112
SAN DIEGO CA
92101
US

V. Phone/Fax

Practice location:
  • Phone: 858-218-6289
  • Fax: 858-218-6289
Mailing address:
  • Phone: 858-218-6289
  • Fax: 858-218-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARIO YOUSIF
Title or Position: PRESIDENT
Credential: NP
Phone: 858-218-6289