Healthcare Provider Details

I. General information

NPI: 1720637820
Provider Name (Legal Business Name): XPERTCARE MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11622 EL CAMINO REAL
SAN DIEGO CA
92130-2049
US

IV. Provider business mailing address

11622 EL CAMINO REAL
SAN DIEGO CA
92130-2049
US

V. Phone/Fax

Practice location:
  • Phone: 443-554-0349
  • Fax:
Mailing address:
  • Phone: 443-554-0349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA R DIENNO
Title or Position: MD
Credential:
Phone: 443-554-0349