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General NPI Number Information
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NPI Number | 1073547667
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES PHYSICIANS OF SAN DIEGO, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 4136 BACHMAN PL
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City | SAN DIEGO
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State | CA
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Zip | 92103-2028
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Country | US
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Telephone | 619-298-1443
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Fax | 619-298-6188
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Provider Business Mailing Address
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Address Line | 4136 BACHMAN PL
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City | SAN DIEGO
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State | CA
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Zip | 92103-2028
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Country | US
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Telephone | 619-298-1443
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Fax | 619-298-6188
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TAMMY PAPPAS
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Credential |
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Telephone | 619-298-1443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G41894
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License Number State | CA
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