Provider Demographics
NPI:1477760247
Name:PARTIDA, JOSE MARIA SR (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MARIA
Last Name:PARTIDA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3202
Mailing Address - Country:US
Mailing Address - Phone:619-420-4246
Mailing Address - Fax:619-420-0770
Practice Address - Street 1:1229 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3202
Practice Address - Country:US
Practice Address - Phone:619-420-4246
Practice Address - Fax:619-420-0770
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C419510Medicaid
CAE11582Medicare UPIN
CAC41951Medicare ID - Type Unspecified