Provider Demographics
NPI:1134333073
Name:ALLERGY ASSOCIATES MEDICAL GROUP INC
Entity type:Organization
Organization Name:ALLERGY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-286-6687
Mailing Address - Street 1:6386 ALVARADO COURT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4907
Mailing Address - Country:US
Mailing Address - Phone:619-286-6687
Mailing Address - Fax:619-286-6695
Practice Address - Street 1:6386 ALVARADO COURT
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4907
Practice Address - Country:US
Practice Address - Phone:619-286-6687
Practice Address - Fax:619-286-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062190Medicaid
W10208Medicare ID - Type Unspecified