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General NPI Number Information
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NPI Number | 1881079986
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Entity Type | Organization
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Legal Business Name | SEASIDE INTEGRATIVE MEDICAL CENTER INC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 02/24/2016
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Provider Practice Location Address
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Address Line | 317 N EL CAMINO REAL SUITE 406
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City | ENCINITAS
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State | CA
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Zip | 92024-2811
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Country | US
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Telephone | 760-452-2305
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Fax |
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Provider Business Mailing Address
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Address Line | 317 N EL CAMINO REAL SUITE 406
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City | ENCINITAS
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State | CA
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Zip | 92024-2811
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Country | US
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Telephone | 760-452-2305
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN WILLIAMSON
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Credential |
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Telephone | 760-452-2305
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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 | A83666
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License Number State | CA
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