Provider Demographics
NPI:1093262255
Name:ALLERGY ABATEMENT AND RELIEF MEDICAL GROUP
Entity Type:Organization
Organization Name:ALLERGY ABATEMENT AND RELIEF MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:LIZERBRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-337-6160
Mailing Address - Street 1:4005 CAMINITO TERVISO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1991
Mailing Address - Country:US
Mailing Address - Phone:858-337-6160
Mailing Address - Fax:858-546-8078
Practice Address - Street 1:4005 CAMINITO TERVISO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1991
Practice Address - Country:US
Practice Address - Phone:858-337-6160
Practice Address - Fax:858-546-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17688207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty