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General NPI Number Information
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NPI Number | 1962947317
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Entity Type | Organization
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Legal Business Name | MARK OLCOTT, M.D., INC.
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 3609 LOTUS DR
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City | SAN DIEGO
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State | CA
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Zip | 92106-1136
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Country | US
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Telephone | 619-261-7427
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Fax |
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Provider Business Mailing Address
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Address Line | 3609 LOTUS DR
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City | SAN DIEGO
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State | CA
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Zip | 92106-1136
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Country | US
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Telephone | 619-261-7427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MARK OLCOTT
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Credential | MD
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Telephone | 619-261-7427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A55234
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License Number State | CA
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