Organization · Type 2 NPI
Agereversalmd.com A Professional Corporation
Public Health or Welfare Agency · La Jolla, CA
NPI number
1194450023
Active
Practice location
3252 Holiday Ct Ste 211
La Jolla, CA 92037-0027
Fax (760) 692-4411
Mailing address
444 N El Camino Real Spc 123
Encinitas, CA 92024-1317
Other practice locations
- 1207 Carlsbad Village Dr Ste Q, Carlsbad, CA 92008-1958 · (760) 944-9200
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gynecology Physician | 207VG0400X | None listed |
| Public Health or Welfare Agency Primary | 251K00000X | None listed |
| Primary Care Clinic/Center | 261QP2300X | None listed |
| Pain Clinic/Center | 261QP3300X | None listed |
Public Health or Welfare Agency: Definition to come...
Another provider at this address
About NPI 1194450023
Agereversalmd.com A Professional Corporation's National Provider Identifier is 1194450023, issued on Jul 24, 2022. The primary taxonomy on file is Public Health or Welfare Agency (251K00000X), and the practice location is in La Jolla, CA. The record was last updated on Jul 24, 2022.