Provider Demographics
NPI:1609915990
Name:SAN DIEGO CRITICAL CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:SAN DIEGO CRITICAL CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-798-0346
Mailing Address - Street 1:PO BOX 2249
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2249
Mailing Address - Country:US
Mailing Address - Phone:619-461-1920
Mailing Address - Fax:619-461-1919
Practice Address - Street 1:2732 NAVAJO RD STE 202A
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-2149
Practice Address - Country:US
Practice Address - Phone:619-461-1920
Practice Address - Fax:619-461-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty