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General NPI Number Information
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NPI Number | 1043497316
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Entity Type | Organization
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Legal Business Name | ADEMA FAMILY MEDICINE, INC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 10201 MISSION GORGE RD STE C
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City | SANTEE
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State | CA
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Zip | 92071-3026
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Country | US
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Telephone | 619-596-5445
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Fax | 619-596-6923
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Provider Business Mailing Address
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Address Line | 10201 MISSION GORGE RD STE C
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City | SANTEE
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State | CA
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Zip | 92071-3026
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Country | US
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Telephone | 619-596-5445
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Fax | 619-596-6923
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Authorized Official
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Title or Position | CEO
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Name | DONALD S ADEMA
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Credential | D.O.
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Telephone | 619-596-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A6239
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License Number State | CA
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