Provider Demographics
NPI:1821267212
Name:PENASQUITOS POINTE MEDICAL GROUP
Entity Type:Organization
Organization Name:PENASQUITOS POINTE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SATNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-484-2000
Mailing Address - Street 1:12880 RANCHO PENASQUITOS BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2966
Mailing Address - Country:US
Mailing Address - Phone:858-484-2000
Mailing Address - Fax:858-484-3414
Practice Address - Street 1:12880 RANCHO PENASQUITOS BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2966
Practice Address - Country:US
Practice Address - Phone:858-484-2000
Practice Address - Fax:858-484-3414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15711111N00000X
CADC15687111N00000X
CAC37664208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15711Medicare PIN
CADC15687Medicare PIN