Healthcare Provider Details

I. General information

NPI: 1366807760
Provider Name (Legal Business Name): MEDZED PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2015
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W A ST STE 200
SAN DIEGO CA
92101-7917
US

IV. Provider business mailing address

440 N BARRANCA AVE # 7665
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 323-203-0070
  • Fax: 323-673-5717
Mailing address:
  • Phone: 323-203-0070
  • Fax: 323-673-5717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JASON CHIRICHIGNO
Title or Position: PRESIDENT
Credential:
Phone: 917-374-9430