Provider Demographics
NPI:1679512024
Name:ESCONDIDO OB-GYN MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ESCONDIDO OB-GYN MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:CIZMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-233-1896
Mailing Address - Street 1:1955 CITRACADO PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4113
Mailing Address - Country:US
Mailing Address - Phone:760-233-1896
Mailing Address - Fax:760-658-6106
Practice Address - Street 1:1955 CITRACADO PKWY STE 302
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4113
Practice Address - Country:US
Practice Address - Phone:760-223-1896
Practice Address - Fax:760-233-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G547460Medicaid
CAW7200Medicare ID - Type Unspecified