Provider Demographics
NPI:1477601748
Name:QUALITYCARE MEDICAL CENTER
Entity Type:Organization
Organization Name:QUALITYCARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:760-730-9992
Mailing Address - Street 1:3142 VISTA WAY
Mailing Address - Street 2:303
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3619
Mailing Address - Country:US
Mailing Address - Phone:760-630-2655
Mailing Address - Fax:760-630-3542
Practice Address - Street 1:2804 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1619
Practice Address - Country:US
Practice Address - Phone:760-730-9992
Practice Address - Fax:760-720-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty