Provider Demographics
NPI:1710020201
Name:NORTH COUNTY GASTROENTEROLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NORTH COUNTY GASTROENTEROLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STARKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-630-0529
Mailing Address - Street 1:3923 WARING RD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4499
Mailing Address - Country:US
Mailing Address - Phone:760-727-8782
Mailing Address - Fax:760-842-7801
Practice Address - Street 1:3923 WARING RD STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4499
Practice Address - Country:US
Practice Address - Phone:760-727-8782
Practice Address - Fax:760-842-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5313715Medicaid
CAZZZ70529ZOtherBLUE SHIELD
CAZZZ70529ZMedicaid