Provider Demographics
NPI:1851368161
Name:SOUTHERN CALIFORNIA HEALTH PROVIDERS MEDICAL GRP INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HEALTH PROVIDERS MEDICAL GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-422-8338
Mailing Address - Street 1:340 FOURTH AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-422-8338
Mailing Address - Fax:619-476-7679
Practice Address - Street 1:340 FOURTH AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-422-8338
Practice Address - Fax:619-476-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty