Provider Demographics
NPI:1609937317
Name:MAURICE BUCHBINDER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MAURICE BUCHBINDER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHBINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-625-4488
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-625-4488
Mailing Address - Fax:858-625-7995
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-625-4488
Practice Address - Fax:858-625-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38176OtherLICENSE