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General NPI Number Information
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NPI Number | 1841884566
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Entity Type | Organization
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Legal Business Name | SPURLOCK MEDICAL CORP
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 4540 KEARNY VILLA RD STE 222
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City | SAN DIEGO
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State | CA
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Zip | 92123-1587
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Country | US
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Telephone | 774-262-4160
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Fax |
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Provider Business Mailing Address
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Address Line | 7037 CANTABERRA CT
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City | SAN DIEGO
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State | CA
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Zip | 92129-4648
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Country | US
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Telephone | 774-262-4160
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JENNIFER SPURLOCK
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Credential | MD
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Telephone | 774-262-4160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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