Provider Demographics
NPI:1447583570
Name:SPECIALTY OBSTETRICS OF SAN DIEGO
Entity Type:Organization
Organization Name:SPECIALTY OBSTETRICS OF SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:858-794-7700
Mailing Address - Street 1:12264 EL CAMINO REAL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3058
Mailing Address - Country:US
Mailing Address - Phone:858-794-7700
Mailing Address - Fax:858-794-7744
Practice Address - Street 1:12264 EL CAMINO REAL
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3058
Practice Address - Country:US
Practice Address - Phone:858-794-7700
Practice Address - Fax:858-794-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80714207VM0101X
CAG47611207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty