MEDICARE: BISSONETTE,FREY,GREENBERG,MALKUS

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	A77230	CA

General Provider Information

NPI Number	:	1639175433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BISSONETTE,FREY,GREENBERG,MALKUS

Provider Business Mailing Address
First Line	:	6280 JACKSON DR
Second Line	:	STE 8
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3436
Country	:	US
Telephone Number	:	619-464-1607
Fax Number	:	619-461-8662

Provider Business Practice Location Address
First Line	:	6280 JACKSON DR
Second Line	:	STE 8
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3436
Country	:	US
Telephone Number	:	619-464-1607
Fax Number	:	619-461-8662

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	DR. DOUGLAS MATTHEW DAUB
Credential	:	MD
Telephone Number	:	619-464-1607

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/22/2020

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Directions to “BISSONETTE,FREY,GREENBERG,MALKUS ” Practice Location

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