Provider Demographics
NPI:1659649754
Name:PHYSICIANS HOME AND HEALTH CARE
Entity Type:Organization
Organization Name:PHYSICIANS HOME AND HEALTH CARE
Other - Org Name:PREFERRED CARE AT HOME CENTRAL COASTAL SAN DIEGO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PETRUZZO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:619-212-7950
Mailing Address - Street 1:5694 MISSION CENTER RD
Mailing Address - Street 2:SUITE 602/346
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4355
Mailing Address - Country:US
Mailing Address - Phone:619-212-7950
Mailing Address - Fax:619-212-7940
Practice Address - Street 1:5694 MISSION CENTER RD
Practice Address - Street 2:SUITE 602/346
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4355
Practice Address - Country:US
Practice Address - Phone:619-212-7950
Practice Address - Fax:619-212-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health