Provider Demographics
NPI:1295158335
Name:MEDI-EXCEL
Entity type:Organization
Organization Name:MEDI-EXCEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-421-1659
Mailing Address - Street 1:750 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6634
Mailing Address - Country:US
Mailing Address - Phone:619-421-1659
Mailing Address - Fax:
Practice Address - Street 1:750 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 2
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6634
Practice Address - Country:US
Practice Address - Phone:619-421-1659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9330486302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization