Provider Demographics
NPI:1982790440
Name:ALLERGY MEDICAL GROUP OF SAN DIEGO, INC.
Entity Type:Organization
Organization Name:ALLERGY MEDICAL GROUP OF SAN DIEGO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MO
Authorized Official - Phone:619-291-2321
Mailing Address - Street 1:2800 THIRD AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:619-291-2321
Mailing Address - Fax:619-294-3429
Practice Address - Street 1:2800 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-291-2321
Practice Address - Fax:619-294-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA16295207RA0201X
CAG71000207RA0201X
CAC28619207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW317Medicare ID - Type Unspecified