Healthcare Provider Details

I. General information

NPI: 1265434096
Provider Name (Legal Business Name): DAVID A. AUSTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2067 W. VISTA WAY SUITE 180
VISTA CA
92083
US

IV. Provider business mailing address

3880 MURPHY CANYON RD. SUITE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 760-945-3434
  • Fax: 760-945-6761
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM-1777
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA92271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: