Provider Demographics
NPI:1013068105
Name:NORTH COUNTY ENDOCRINE MEDICAL GROUP
Entity Type:Organization
Organization Name:NORTH COUNTY ENDOCRINE MEDICAL GROUP
Other - Org Name:ADVANCED METABOLIC CARE & RESEARCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SILLECK
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-743-1431
Mailing Address - Street 1:625 W CITRACADO PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6248
Mailing Address - Country:US
Mailing Address - Phone:760-743-1431
Mailing Address - Fax:760-743-6455
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-743-1431
Practice Address - Fax:760-743-6455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH COUNTY ENDOCRINE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32416174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW1731Medicare UPIN
CAZZZ37242ZMedicare UPIN