Provider Demographics
NPI:1720637820
Name:XPERTCARE MEDICAL GROUP PC
Entity Type:Organization
Organization Name:XPERTCARE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIENNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-554-0349
Mailing Address - Street 1:11622 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2049
Mailing Address - Country:US
Mailing Address - Phone:443-554-0349
Mailing Address - Fax:
Practice Address - Street 1:11622 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2049
Practice Address - Country:US
Practice Address - Phone:443-554-0349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty