Healthcare Provider Details

I. General information

NPI: 1982790440
Provider Name (Legal Business Name): ALLERGY MEDICAL GROUP OF SAN DIEGO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 THIRD AVENUE
SAN DIEGO CA
92103
US

IV. Provider business mailing address

2800 THIRD AVENUE
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-2321
  • Fax: 619-294-3429
Mailing address:
  • Phone: 619-291-2321
  • Fax: 619-294-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA16295
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberG71000
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC28619
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD M BRANDON
Title or Position: PRESIDENT
Credential: M.O.
Phone: 619-291-2321