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General NPI Number Information
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NPI Number | 1013068105
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Entity Type | Organization
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Legal Business Name | NORTH COUNTY ENDOCRINE MEDICAL GROUP
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 625 W CITRACADO PKWY SUITE 108
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City | ESCONDIDO
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State | CA
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Zip | 92025
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Country | US
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Telephone | 760-743-1431
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Fax | 760-743-6455
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Provider Business Mailing Address
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Address Line | 625 W CITRACADO PKWY SUITE 108
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City | ESCONDIDO
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State | CA
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Zip | 92025-6248
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Country | US
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Telephone | 760-743-1431
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Fax | 760-743-6455
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TIMOTHY SILLECK BAILEY
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Credential | M.D.
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Telephone | 760-743-1431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A32416
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License Number State | CA
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