Healthcare Provider Details

I. General information

NPI: 1538433198
Provider Name (Legal Business Name): SPECIALIZED MEDICAL CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 GAINES ST
SAN DIEGO CA
92110-1441
US

IV. Provider business mailing address

5995 GAINES ST
SAN DIEGO CA
92110-1441
US

V. Phone/Fax

Practice location:
  • Phone: 619-726-8290
  • Fax:
Mailing address:
  • Phone: 619-726-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name: RAY A GROSS
Title or Position: OWNER
Credential:
Phone: 619-726-8290