| Identity Medical Group, Inc. | |
|
751 E Daily Dr Suite 120 Camarillo CA 93010-6076 | |
| (805) 256-7810 | |
| (805) 256-7840 |
| Full Name | Identity Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 751 E Daily Dr, Camarillo, California |
| Authorized Official Name and Position | Gary M. Deutsch, (GENERAL PARTNER) |
| Authorized Official Contact | 8052567810 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Identity Medical Group, Inc. 751 E Daily Dr Suite 120 Camarillo CA 93010-6076 Ph: (805) 256-7810 | Identity Medical Group, Inc. 751 E Daily Dr Suite 120 Camarillo CA 93010-6076 Ph: (805) 256-7810 |
| NPI Number | 1326384512 |
|---|---|
| Provider Enumeration Date | 12/17/2012 |
| Last Update Date | 11/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326384512 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (California) | Primary |
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