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General NPI Number Information
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NPI Number | 1184674830
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Entity Type | Organization
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Legal Business Name | SAN MARCOS MEDICAL GROUP INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 1574 W BASE LINE ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1736
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Country | US
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Telephone | 909-881-7320
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Fax | 909-881-7330
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Provider Business Mailing Address
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Address Line | 1574 W BASE LINE ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92411-1736
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Country | US
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Telephone | 909-881-7320
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Fax | 909-881-7330
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Authorized Official
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Title or Position | COORDINATOR
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Name | SANDRA GONZALEZ
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Credential |
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Telephone | 909-376-4438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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