Provider Demographics
NPI:1780154864
Name:CARLSBAD FAMILY MEDICINE
Entity type:Organization
Organization Name:CARLSBAD FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-688-0411
Mailing Address - Street 1:2808 ROOSEVELT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1688
Mailing Address - Country:US
Mailing Address - Phone:760-688-0411
Mailing Address - Fax:760-645-6385
Practice Address - Street 1:2808 ROOSEVELT ST STE 100
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1688
Practice Address - Country:US
Practice Address - Phone:760-688-0411
Practice Address - Fax:760-645-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center