NPI 1194450023 · live from the CMS NPI Registry
Agereversalmd.Com A Professional Corporation
Public Health or Welfare in La Jolla, CA. National Provider Identifier 1194450023, active.
NPI record
| NPI | 1194450023 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Public Health or Welfare 251K00000X |
| Practice location | 3252 Holiday Ct Ste 211, La Jolla, CA 92037 |
| Practice phone | 858-776-0544 |
| Mailing address | 444 N El Camino Real Spc 123, Encinitas, CA 92024 |
| Enumerated | July 24, 2022 |
| Last updated | July 24, 2022 |
| Authorized official | Phillip Milgram, Ceo |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Obstetrics & Gynecology, Gynecology | 207VG0400X | — |
| Clinic/Center, Primary Care | 261QP2300X | — |
| Clinic/Center, Pain | 261QP3300X | — |
| Public Health or Welfare primary | 251K00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.