Provider Demographics
NPI:1598915704
Name:PHYSICIAN MEDICAL RESOURCE
Entity Type:Organization
Organization Name:PHYSICIAN MEDICAL RESOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELASERNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:8778-631-3936
Mailing Address - Street 1:1341 E. VALLEY PARKWAY
Mailing Address - Street 2:#219
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1341 E VALLEY PKWY
Practice Address - Street 2:#219
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2311
Practice Address - Country:US
Practice Address - Phone:877-863-1396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty