Healthcare Provider Details

I. General information

NPI: 1720035744
Provider Name (Legal Business Name): ENCOMPASS FAMILY PHYSICIAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 AUSTIN DR STE # 103
SPRING VALLEY CA
91978-1500
US

IV. Provider business mailing address

10225 AUSTIN DR STE # 103
SPRING VALLEY CA
91978-1500
US

V. Phone/Fax

Practice location:
  • Phone: 619-660-5719
  • Fax: 619-660-5934
Mailing address:
  • Phone: 619-660-5719
  • Fax: 619-660-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAILY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 619-660-5719