Provider Demographics
NPI:1467713107
Name:THE PHYSICIANS MEDICAL TRIALS NETWORK
Entity Type:Organization
Organization Name:THE PHYSICIANS MEDICAL TRIALS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-656-5444
Mailing Address - Street 1:1881 MEEKS BAY DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1651
Mailing Address - Country:US
Mailing Address - Phone:619-656-5444
Mailing Address - Fax:619-656-5444
Practice Address - Street 1:1881 MEEKS BAY DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1651
Practice Address - Country:US
Practice Address - Phone:619-656-5444
Practice Address - Fax:619-656-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty