Healthcare Provider Details

I. General information

NPI: 1184782724
Provider Name (Legal Business Name): PRIMARY CARE ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 LAKE SAN MARCOS DR STE 201
SAN MARCOS CA
92078-4698
US

IV. Provider business mailing address

1635 LAKE SAN MARCOS DR STE 201
SAN MARCOS CA
92078-4698
US

V. Phone/Fax

Practice location:
  • Phone: 760-471-9444
  • Fax: 760-471-4886
Mailing address:
  • Phone: 760-471-9444
  • Fax: 760-471-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY L SHIRLEY
Title or Position: DIRECTOR QUALITY MANAGMENT
Credential:
Phone: 760-471-9444