Healthcare Provider Details

I. General information

NPI: 1497982193
Provider Name (Legal Business Name): JEFFREY K PEARSON A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CRAVEN RD SUITE 101
SAN MARCOS CA
92078-4235
US

IV. Provider business mailing address

120 CRAVEN RD SUITE 101
SAN MARCOS CA
92078-4235
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-0955
  • Fax: 760-591-3680
Mailing address:
  • Phone: 760-591-0955
  • Fax: 760-591-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA45444
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY K PEARSON
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 760-591-0955