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13280 Evening Creek Dr S Ste 225 San Diego CA 92128-4664 | |
| (877) 257-0637 | |
| (888) 630-5711 |
| Full Name | |
|---|---|
| Speciality | General Practice |
| Location | 13280 Evening Creek Dr S Ste 225, San Diego, California |
| Authorized Official Name and Position | Vishal Verma (CEO) |
| Authorized Official Contact | 8772570637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13280 Evening Creek Dr S Ste 225 San Diego CA 92128-4664 Ph: (877) 257-0637 | 13280 Evening Creek Dr S Ste 225 San Diego CA 92128-4664 Ph: (877) 257-0637 |
| NPI Number | 1275145138 |
|---|---|
| Provider Enumeration Date | 08/20/2020 |
| Last Update Date | 11/01/2024 |
| Medicare PECOS PAC ID | 8426035775 |
|---|---|
| Medicare Enrollment ID | O20040702001258 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275145138 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jules Pean |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1164476602 PECOS PAC ID: 9234037987 Enrollment ID: I20050824000799 |
| Provider Name | Samir Damani |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457379372 PECOS PAC ID: 9830194406 Enrollment ID: I20061003000751 |
| Provider Name | Jason Michael Phillips |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1417120387 PECOS PAC ID: 4486872991 Enrollment ID: I20140825002812 |
| Provider Name | Maranda Mccray-dixon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154595304 PECOS PAC ID: 1254501992 Enrollment ID: I20180327003110 |
| Provider Name | Kate Cordisco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003246851 PECOS PAC ID: 0345467247 Enrollment ID: I20210309001617 |
| Provider Name | Atif Rasheed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437348182 PECOS PAC ID: 4587722418 Enrollment ID: I20220323002269 |
| Provider Name | Gina Rigsbee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598387425 PECOS PAC ID: 5496167934 Enrollment ID: I20220810002043 |
| Provider Name | Elaine Briggs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700105673 PECOS PAC ID: 1456545326 Enrollment ID: I20230224001855 |
| Provider Name | Terri Riddiford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649279498 PECOS PAC ID: 9931173911 Enrollment ID: I20240102004128 |
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