| Advanced Pediatric Medical Group Inc | |
|
5222 Balboa Ave Suite 42 San Diego CA 92117-6904 | |
| (858) 268-0702 | |
| (858) 268-0374 |
| Full Name | Advanced Pediatric Medical Group Inc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 5222 Balboa Ave, San Diego, California |
| Authorized Official Name and Position | Jay Jalal Sadrieh (PRESIDENT AND OFFICER) |
| Authorized Official Contact | 8582680702 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Pediatric Medical Group Inc 5222 Balboa Ave Suite 42 San Diego CA 92117-6991 Ph: (858) 268-0702 | Advanced Pediatric Medical Group Inc 5222 Balboa Ave Suite 42 San Diego CA 92117-6904 Ph: (858) 268-0702 |
| NPI Number | 1558459180 |
|---|---|
| Provider Enumeration Date | 10/10/2006 |
| Last Update Date | 02/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558459180 | NPI | - | NPPES |
| GR0071320 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A46462 (California) | Primary |
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