Presidio Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PRESIDIO MEDICAL GROUP INC

Practice address

4440 Lamont St
San Diego, CA 92109-4560

Phone

(858) 270-7633

Fax

(858) 270-7692

NPI assigned

Oct 16, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James A Novak, M.D.

Title

President

Phone

(858) 272-0022

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003996216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 LAMONT ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921094560",
            "telephone_number": "858-270-7633",
            "fax_number": "858-270-7692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 LAMONT ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921094560",
            "telephone_number": "858-270-7633",
            "fax_number": "858-270-7692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESIDIO MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-272-0022",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elise C Prepetit
• Prescribed Oxygen Inc
• Asaf Presente, M.D.,PH.D.
• Presidio Diagnostics LLC
• Presidio Diagnostics LLC
• Presioca Duval Services, LLC
• Catalina Peters Preskill, MD
• David Benjamin Preskill, MD
• Dena Presotto, SLP
• Gary A. Press, MD

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.