Provider Demographics
NPI:1639871627
Name:9AMHEALTH MEDICAL GROUP OF CALIFORNIA, P.C.
Entity Type:Organization
Organization Name:9AMHEALTH MEDICAL GROUP OF CALIFORNIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTEFANO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:380-400-9215
Mailing Address - Street 1:914 N COAST HIGHWAY 101 STE A
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2074
Mailing Address - Country:US
Mailing Address - Phone:202-932-9958
Mailing Address - Fax:844-927-4824
Practice Address - Street 1:914 N COAST HIGHWAY 101
Practice Address - Street 2:STE A
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2074
Practice Address - Country:US
Practice Address - Phone:202-932-9958
Practice Address - Fax:844-927-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty