Healthcare Provider Details

I. General information

NPI: 1144644170
Provider Name (Legal Business Name): ARTEMIS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 WASHINGTON ST SUITE 200
SAN DIEGO CA
92103-2209
US

IV. Provider business mailing address

770 WASHINGTON ST SUITE 200
SAN DIEGO CA
92103-2209
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-3636
  • Fax: 858-278-3637
Mailing address:
  • Phone: 858-278-3636
  • Fax: 858-278-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberA67412
License Number StateCA

VIII. Authorized Official

Name: DR. VISHAAL MEHRA
Title or Position: PRESIDENT
Credential: MD
Phone: 858-278-3647