MEDICARE: EURIS COLON

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
1	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1376870634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EURIS COLON

Provider Business Mailing Address
First Line	:	1816 GARNET AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	858-274-8888
Fax Number	:	858-220-7526

Provider Business Practice Location Address
First Line	:	1816 GARNET AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3352
Country	:	US
Telephone Number	:	858-274-8888
Fax Number	:	858-220-7526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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Directions to “ EURIS COLON ” Practice Location

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