| Cassidy Medical Group - Sw | |
|
2095 W Vista Way Ste 218 Vista CA 92083-6029 | |
| (760) 630-3562 | |
| (760) 630-2559 |
| Full Name | Cassidy Medical Group - Sw |
|---|---|
| Speciality | Family Medicine |
| Location | 2095 W Vista Way Ste 218, Vista, California |
| Authorized Official Name and Position | Judith M Krueger (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7606305487 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cassidy Medical Group - Sw 2095 W Vista Way Ste 218 Vista CA 92083-6029 Ph: (760) 630-3562 | Cassidy Medical Group - Sw 2095 W Vista Way Ste 218 Vista CA 92083-6029 Ph: (760) 630-3562 |
| NPI Number | 1093882359 |
|---|---|
| Provider Enumeration Date | 11/29/2006 |
| Last Update Date | 10/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093882359 | NPI | - | NPPES |
| 3016 | Other | CA | NEIC SITE ID, NSF BA0-7 |
| GROO60602 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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