Provider Demographics
NPI:1508845983
Name:BOSCH, PHILIP C (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:C
Last Name:BOSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:651 E PENNSYLVANIA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3053
Mailing Address - Country:US
Mailing Address - Phone:760-743-3135
Mailing Address - Fax:760-743-7424
Practice Address - Street 1:651 E PENNSYLVANIA AVE
Practice Address - Street 2:STE 201
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3053
Practice Address - Country:US
Practice Address - Phone:760-743-3135
Practice Address - Fax:760-743-7424
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46782208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G467210Medicaid
CAA92676Medicare UPIN
CAG046782Medicare ID - Type Unspecified