Provider Demographics
NPI:1346420510
Name:SAN DIEGO CENTER FOR GYN ONCOLOGY INC
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR GYN ONCOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-471-0200
Mailing Address - Street 1:955 BOARDWALK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2659
Mailing Address - Country:US
Mailing Address - Phone:760-471-0200
Mailing Address - Fax:760-471-0211
Practice Address - Street 1:955 BOARDWALK
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2659
Practice Address - Country:US
Practice Address - Phone:760-471-0200
Practice Address - Fax:760-471-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty