Provider Demographics
NPI:1053845578
Name:FIT ATHLETIC SOLANA BEACH LLC
Entity Type:Organization
Organization Name:FIT ATHLETIC SOLANA BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-675-4480
Mailing Address - Street 1:511 S HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2211
Mailing Address - Country:US
Mailing Address - Phone:858-792-4008
Mailing Address - Fax:
Practice Address - Street 1:511 S HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2211
Practice Address - Country:US
Practice Address - Phone:858-792-4008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty