Provider Demographics
NPI:1326199274
Name:SAN DIEGO MEDICAL ELECTRONICS, INC.
Entity Type:Organization
Organization Name:SAN DIEGO MEDICAL ELECTRONICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-599-9496
Mailing Address - Street 1:5245 AVENIDA ENCINAS
Mailing Address - Street 2:SUITE H
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4369
Mailing Address - Country:US
Mailing Address - Phone:760-599-9496
Mailing Address - Fax:760-599-9001
Practice Address - Street 1:5245 AVENIDA ENCINAS
Practice Address - Street 2:SUITE H
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4369
Practice Address - Country:US
Practice Address - Phone:760-599-9496
Practice Address - Fax:760-599-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100305332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00179FMedicaid
CA0274240001Medicare NSC