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General NPI Number Information
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NPI Number | 1568775161
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Entity Type | Organization
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Legal Business Name | FUNCTIONMD MEDICAL CENTER
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 215 S HICKORY ST SUITE 118
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City | ESCONDIDO
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State | CA
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Zip | 92025-4359
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Country | US
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Telephone | 760-432-6644
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Fax | 760-739-8213
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Provider Business Mailing Address
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Address Line | 215 S HICKORY ST SUITE 118
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City | ESCONDIDO
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State | CA
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Zip | 92025-4359
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JEFFREY CHEN
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Credential | MD
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Telephone | 949-682-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A102762
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License Number State | CA
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