Healthcare Provider Details

I. General information

NPI: 1518364165
Provider Name (Legal Business Name): TRI-CITY PRIMARY CARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 VIA CENTRE DRIVE STE A
VISTA CA
92081-6056
US

IV. Provider business mailing address

1926 VIA CENTRE DRIVE STE A
VISTA CA
92081-6056
US

V. Phone/Fax

Practice location:
  • Phone: 760-940-7000
  • Fax: 760-940-0042
Mailing address:
  • Phone: 760-940-7000
  • Fax: 760-940-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DEANINE DOLPHIN
Title or Position: BILLING & COLLECTIONS MANAGER
Credential:
Phone: 760-477-2101