Basic Information
| Provider Information | |||||||||
| NPI: | 1720271513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CSSD II A MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3860 CALLE FORTUNADA | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583096300 | ||||||||
| FaxNumber: | 8585769637 | ||||||||
| Practice Location | |||||||||
| Address1: | 3860 CALLE FORTUNADA | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921234800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583096280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2007 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOMEZ | ||||||||
| AuthorizedOfficialFirstName: | BOBBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR TPA SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8583096280 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.