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General NPI Number Information
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NPI Number | 1477601748
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Entity Type | Organization
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Legal Business Name | QUALITYCARE MEDICAL CENTER
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2804 ROOSEVELT ST
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City | CARLSBAD
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State | CA
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Zip | 92008-1619
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Country | US
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Telephone | 760-730-9992
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Fax | 760-720-0897
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Provider Business Mailing Address
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Address Line | 3142 VISTA WAY 303
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City | OCEANSIDE
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State | CA
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Zip | 92056-3619
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Country | US
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Telephone | 760-630-2655
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Fax | 760-630-3542
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL J NELMS
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Credential | PA-C
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Telephone | 760-730-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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