Healthcare Provider Details

I. General information

NPI: 1871572156
Provider Name (Legal Business Name): ATHANASIOS JAMES FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 STEVENS AVE SUITE 100
SOLANA BEACH CA
92075-2063
US

IV. Provider business mailing address

10170 SORRENTO VALLEY RD
SAN DIEGO CA
92121-1604
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-9800
  • Fax:
Mailing address:
  • Phone: 858-784-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC37725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: