Provider Demographics
NPI:1457841777
Name:HEALTHY AGING CENTERS
Entity Type:Organization
Organization Name:HEALTHY AGING CENTERS
Other - Org Name:GAMEDAY MEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:NAFICY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-252-9202
Mailing Address - Street 1:2753 JEFFERSON ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1704
Mailing Address - Country:US
Mailing Address - Phone:858-252-9202
Mailing Address - Fax:
Practice Address - Street 1:2753 JEFFERSON ST STE 204
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1704
Practice Address - Country:US
Practice Address - Phone:949-542-9717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty