Provider Demographics
NPI:1477856367
Name:SAN DIEGO CENTER FOR INTEGRATIVE MEDICINE INC A CA PC
Entity Type:Organization
Organization Name:SAN DIEGO CENTER FOR INTEGRATIVE MEDICINE INC A CA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:AIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-670-8028
Mailing Address - Street 1:6331 DWANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3835
Mailing Address - Country:US
Mailing Address - Phone:619-670-8028
Mailing Address - Fax:619-670-9675
Practice Address - Street 1:8875 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-5434
Practice Address - Country:US
Practice Address - Phone:619-670-8028
Practice Address - Fax:619-670-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAER305AMedicare PIN