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General NPI Number Information
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NPI Number | 1457495046
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Entity Type | Organization
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Legal Business Name | FALLBROOK MEDICAL GROUP, INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 504 E ALVARADO ST STE 201
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City | FALLBROOK
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State | CA
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Zip | 92028-2364
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Country | US
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Telephone | 760-731-0352
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Fax | 760-731-2151
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Provider Business Mailing Address
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Address Line | 504 E ALVARADO ST STE 201
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City | FALLBROOK
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State | CA
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Zip | 92028-2364
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Country | US
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Telephone | 760-731-0352
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Fax | 760-731-2151
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. BARBARA GORDON
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Credential |
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Telephone | 760-731-0352
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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 | G23092
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C36017
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G36388
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License Number State | CA
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