Provider Demographics
NPI:1093417206
Name:MDS BY THE SEA INC
Entity Type:Organization
Organization Name:MDS BY THE SEA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-483-6694
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0300
Mailing Address - Country:US
Mailing Address - Phone:619-483-6694
Mailing Address - Fax:
Practice Address - Street 1:1200 N COAST HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1441
Practice Address - Country:US
Practice Address - Phone:619-483-6694
Practice Address - Fax:858-227-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty