Healthcare Provider Details

I. General information

NPI: 1750079380
Provider Name (Legal Business Name): MARK ANTHONY KHALIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 VIA CTR STE A
VISTA CA
92081-6056
US

IV. Provider business mailing address

12967 LONGBOAT WAY
DEL MAR CA
92014-3829
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-7000
  • Fax:
Mailing address:
  • Phone: 858-342-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206589
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: