Healthcare Provider Details

I. General information

NPI: 1750434403
Provider Name (Legal Business Name): INTEGRATIVE MEDICINE ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 6TH AVE STE 412
SAN DIEGO CA
92103-6315
US

IV. Provider business mailing address

2850 6TH AVE STE 412
SAN DIEGO CA
92103-6315
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-2555
  • Fax: 619-422-2223
Mailing address:
  • Phone: 619-422-2555
  • Fax: 619-422-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA35411
License Number StateCA

VIII. Authorized Official

Name: DR. PHILLIP MARK MILGRAM
Title or Position: OWNER
Credential: MD
Phone: 619-422-2555