Healthcare Provider Details

I. General information

NPI: 1528733185
Provider Name (Legal Business Name): ASHEH & DAUGHETY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16766 BERNARDO CENTER DR STE 206
SAN DIEGO CA
92128-2502
US

IV. Provider business mailing address

12842 STONE CANYON RD
POWAY CA
92064-2037
US

V. Phone/Fax

Practice location:
  • Phone: 858-848-5249
  • Fax: 451-728-9751
Mailing address:
  • Phone: 619-929-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON DAUGHETY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 619-929-4343