Provider Demographics
NPI:1649257361
Name:ALLERGY & ASTHMA MEDICAL GROUP & RESEARCH CENTER, A P.C.
Entity type:Organization
Organization Name:ALLERGY & ASTHMA MEDICAL GROUP & RESEARCH CENTER, A P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-292-1144
Mailing Address - Street 1:5776 RUFFIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1013
Mailing Address - Country:US
Mailing Address - Phone:858-292-1144
Mailing Address - Fax:858-268-5145
Practice Address - Street 1:5776 RUFFIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1013
Practice Address - Country:US
Practice Address - Phone:858-292-1144
Practice Address - Fax:858-268-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028000Medicaid
CAGR0028000Medicaid
CAA91634Medicare UPIN
CAH58490Medicare UPIN
CAA90478Medicare UPIN
CAW11379Medicare ID - Type Unspecified