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General NPI Number Information
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NPI Number | 1356569834
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Entity Type | Organization
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Legal Business Name | NORTH COAST FAMILY MEDICAL GROUP
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 477 N. EL CAMINO REAL A306
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City | ENCINITAS
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State | CA
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Zip | 92024-1350
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Country | US
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Telephone | 760-942-0118
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Fax | 760-942-5319
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Provider Business Mailing Address
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Address Line | 477 N. EL CAMINO REAL A306
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City | ENCINITAS
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State | CA
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Zip | 92024-1350
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Country | US
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Telephone | 760-942-0118
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Fax | 760-942-5319
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Authorized Official
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Title or Position | CEO
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Name | CRAIG S DUCK
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Credential | MD
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Telephone | 760-942-0118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G50467
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License Number State | CA
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