Provider Demographics
NPI:1346373305
Name:SOUTHERN CALIFORNIA PERINATAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PERINATAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:TRIFUNOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-480-6000
Mailing Address - Street 1:1035 E GRAND AVE
Mailing Address - Street 2:#101
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-480-6000
Mailing Address - Fax:760-480-2621
Practice Address - Street 1:1035 E GRAND AVE
Practice Address - Street 2:#101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-480-6000
Practice Address - Fax:760-480-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065521Medicaid