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NPI Code Detail

MEDICARE: LAS PALMAS MEDICAL GROUP

MEDICARE: LAS PALMAS MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianG57022CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063718930
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAS PALMAS MEDICAL GROUP
Provider Business Mailing Address
First Line : 1540 E VALLEY PKWY
Second Line :
City : ESCONDIDO
State : CA
Zip : 92027-2316
Country : US
Telephone Number : 760-621-4902
Fax Number : 760-400-0012
Provider Business Practice Location Address
First Line : 1540 E VALLEY PKWY
Second Line :
City : ESCONDIDO
State : CA
Zip : 92027-2316
Country : US
Telephone Number : 760-621-4902
Fax Number : 760-400-0012
Authorized Official
Title or Position : OFFICE MANAGER
Name : CARLOS MENA
Credential :
Telephone Number : 760-480-4747
Provider Enumeration Date : 02/09/2011
Last Update Date : 02/14/2011

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Directions to “LAS PALMAS MEDICAL GROUP ” Practice Location

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