Provider Demographics
NPI:1154861979
Name:ELIZABETH SUPPORTIVE MEDICAL SPECIALISTS, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELIZABETH SUPPORTIVE MEDICAL SPECIALISTS, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-737-2050
Mailing Address - Street 1:800 W VALLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-2557
Mailing Address - Country:US
Mailing Address - Phone:760-737-2050
Mailing Address - Fax:760-796-3781
Practice Address - Street 1:27720 JEFFERSON AVE STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2630
Practice Address - Country:US
Practice Address - Phone:760-737-2050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty