Provider Demographics
NPI:1720035744
Name:ENCOMPASS FAMILY PHYSICIAN MEDICAL GROUP
Entity Type:Organization
Organization Name:ENCOMPASS FAMILY PHYSICIAN MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-660-5719
Mailing Address - Street 1:10225 AUSTIN DR
Mailing Address - Street 2:STE # 103
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1500
Mailing Address - Country:US
Mailing Address - Phone:619-660-5719
Mailing Address - Fax:619-660-5934
Practice Address - Street 1:10225 AUSTIN DR
Practice Address - Street 2:STE # 103
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1500
Practice Address - Country:US
Practice Address - Phone:619-660-5719
Practice Address - Fax:619-660-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11716GMedicare PIN
CAW11716AMedicare PIN
CAW11716BMedicare PIN
CAW11716FMedicare PIN
CAW11716EMedicare PIN