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General NPI Number Information
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NPI Number | 1366872681
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Entity Type | Organization
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Legal Business Name | CARLSBAD VILLAGE FAMILY PRACTICE MEDICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 2801 JEFFERSON ST
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City | CARLSBAD
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State | CA
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Zip | 92008-1720
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Country | US
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Telephone | 760-729-4952
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Fax | 760-729-1518
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Provider Business Mailing Address
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Address Line | 2801 JEFFERSON ST
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City | CARLSBAD
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State | CA
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Zip | 92008-1720
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Country | US
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Telephone | 760-729-4952
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Fax | 760-729-1518
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MICHELLE JONES
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Credential |
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Telephone | 760-729-4952
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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 | 20A6683
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License Number State | CA
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