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General NPI Number Information
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NPI Number | 1447521265
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Entity Type | Organization
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Legal Business Name | FREDERICK W CLOSE, MD, INC
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DR BLDG 3 STE 156
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-462-0900
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Fax | 619-462-3584
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Provider Business Mailing Address
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Address Line | 5565 GROSSMONT CENTER DR BLDG 3 STE 156
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City | LA MESA
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State | CA
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Zip | 91942-3020
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Country | US
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Telephone | 619-462-0900
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Fax | 619-462-3584
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELIZABETH A MESSINA
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Credential |
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Telephone | 619-462-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | C36625
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License Number State | CA
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