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General NPI Number Information
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NPI Number | 1033544408
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Entity Type | Organization
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Legal Business Name | SEA BREEZE PEDIATRICS, APC
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 12395 EL CAMINO REAL SUITE 311
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City | SAN DIEGO
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State | CA
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Zip | 92130-3082
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Country | US
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Telephone | 858-350-4901
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Fax | 858-350-4904
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Provider Business Mailing Address
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Address Line | 12395 EL CAMINO REAL SUITE 311
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City | SAN DIEGO
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State | CA
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Zip | 92130-3082
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Country | US
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Telephone | 858-350-4901
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Fax | 858-350-4904
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT LAMAR BJORK JR.
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Credential | M.D.
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Telephone | 858-350-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A39787
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License Number State | CA
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