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General NPI Number Information
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NPI Number | 1427076009
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Entity Type | Organization
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Legal Business Name | MEDICUS MD INC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 3969 4TH AVE STE #203
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City | SAN DIEGO
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State | CA
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Zip | 92103-3165
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Country | US
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Telephone | 619-294-6500
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Fax | 619-294-6505
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Provider Business Mailing Address
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Address Line | 3969 4TH AVE STE #203
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City | SAN DIEGO
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State | CA
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Zip | 92103-3165
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Country | US
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Telephone | 619-294-6500
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Fax | 619-294-6505
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BARBARA DENYSIAK
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Credential | MD
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Telephone | 619-294-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A48505
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License Number State | CA
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