Healthcare Provider Details

I. General information

NPI: 1548824063
Provider Name (Legal Business Name): SYMMETRY MEDICAL INFUSIONS SAN DIEGO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 FIFTH AVE STE 300
SAN DIEGO CA
92103-4230
US

IV. Provider business mailing address

3943 IRVINE BLVD STE 628
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 310-740-7864
  • Fax: 949-449-8325
Mailing address:
  • Phone: 310-740-7864
  • Fax: 949-449-8325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY BRAGANZA
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 323-341-4786