Provider Demographics
NPI:1326389586
Name:KEVIN LEE METROS, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KEVIN LEE METROS, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:METROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-738-7224
Mailing Address - Street 1:735 E OHIO AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3437
Mailing Address - Country:US
Mailing Address - Phone:760-738-7224
Mailing Address - Fax:760-738-6138
Practice Address - Street 1:735 E OHIO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3437
Practice Address - Country:US
Practice Address - Phone:760-738-7224
Practice Address - Fax:760-738-6138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71444OtherMEDICAL LICENSE
CAE22627Medicare UPIN