Provider Demographics
NPI:1598986507
Name:INFERTILITY OBSTETRICS & GYNECOLOGY MEDICAL GROUP OF CHULA VISTA
Entity Type:Organization
Organization Name:INFERTILITY OBSTETRICS & GYNECOLOGY MEDICAL GROUP OF CHULA VISTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-422-2104
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:STE 211
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-422-2000
Mailing Address - Fax:619-422-2961
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:# 211
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-422-2000
Practice Address - Fax:619-422-2961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW5166Medicare PIN