Healthcare Provider Details

I. General information

NPI: 1699154401
Provider Name (Legal Business Name): SYNERGY SPECIALISTS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST ST SUITE 340
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

4445 EASTGATE MALL SUITE 105
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 858-277-2448
  • Fax: 858-277-2492
Mailing address:
  • Phone: 858-412-6080
  • Fax: 858-412-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. TAL S DAVID
Title or Position: PRESIDENT
Credential: MD
Phone: 858-571-9500