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NPI Code Detail

MEDICARE: FAIRMOUNT MEDICAL CLINIC

MEDICARE: FAIRMOUNT MEDICAL CLINIC
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
1207Q00000XFamily Medicine Physician
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1760655534
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAIRMOUNT MEDICAL CLINIC
Provider Business Mailing Address
First Line : 4074 FAIRMONT AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-1608
Country : US
Telephone Number : 619-325-1819
Fax Number :
Provider Business Practice Location Address
First Line : 4074 FAIRMONT AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-1608
Country : US
Telephone Number : 619-325-1819
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. MOHAMMED T BAILONY
Credential : M.D.
Telephone Number : 619-475-9174
Provider Enumeration Date : 04/11/2008
Last Update Date : 04/11/2008

Similar Medicare Providers

1417892175 — LALEH RAHMANI
Practice Location Address:
4060 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-280-4213
Practice Fax:
1063405777 — DR. JARED HEATH HEIMBIGNER D.O.
Practice Location Address:
4060 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-584-1612
Practice Fax:
1447246640 — MICHAEL SPENCER GIBSON M.D.
Practice Location Address:
4060 FAIRMOUNT AVE STE 120
SAN DIEGO, CA
92105-1608
Practice Phone: 619-269-1299
Practice Fax: 619-961-0812
1609849074 — LA MAESTRA FAMILY CLINIC, INC.
Practice Location Address:
4060 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-280-4213
Practice Fax: 619-281-6738
1740254713 — DR. WADI ROUEL M.D.
Practice Location Address:
4060 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-584-1612
Practice Fax: 619-281-6738
1518929876 — EUGENE JOSEPH BASILIERE M.D
Practice Location Address:
4060 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-280-4213
Practice Fax:
1609887199 — WHITE CROSS DRUG STORE
Practice Location Address:
4074 FAIRMOUNT AVE
SAN DIEGO, CA
92105-1608
Practice Phone: 619-284-1141
Practice Fax: 619-284-0503

Directions to “FAIRMOUNT MEDICAL CLINIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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