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General NPI Number Information
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NPI Number | 1669472510
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Entity Type | Organization
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Legal Business Name | SD SPORTS MEDICINE AND FAMILY HEALTH CENTER
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 6699 ALVARADO RD STE 2100
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City | SAN DIEGO
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State | CA
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Zip | 92120-5238
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Country | US
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Telephone | 619-229-3909
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Fax | 619-229-3902
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Provider Business Mailing Address
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Address Line | 6699 ALVARADO RD STE 2100
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City | SAN DIEGO
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State | CA
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Zip | 92120-5238
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Country | US
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Telephone | 619-229-3909
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Fax | 619-229-3902
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | DR. RICHARD A. PARKER
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Credential | D.O.
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Telephone | 619-229-3909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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