Healthcare Provider Details

I. General information

NPI: 1306938386
Provider Name (Legal Business Name): DEL MAR MED A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL STE 200
SAN DIEGO CA
92130-3083
US

IV. Provider business mailing address

12395 EL CAMINO REAL STE 200
SAN DIEGO CA
92130-3083
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-6647
  • Fax:
Mailing address:
  • Phone: 858-755-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY EATON
Title or Position: MD PRESIDENT
Credential:
Phone: 858-755-6647