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General NPI Number Information
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NPI Number | 1073590105
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-4500
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Country | US
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Telephone | 760-724-5173
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Fax | 760-724-5265
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Provider Business Mailing Address
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Address Line | 3998 VISTA WAY SUITE B
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City | OCEANSIDE
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State | CA
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Zip | 92056-4500
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Country | US
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Telephone | 760-724-5173
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Fax | 760-724-5265
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. JEANNETTE BRODY
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Credential |
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Telephone | 760-724-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A47884
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA17120
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A70831
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A68137
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4564
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A70831
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License Number State | CA
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