NPIMap

Organization Active NPI

Ejd Medical Corporation

  • Neurology Physician
  • San Diego, CA
National Provider Identifier
1295962082
Registry record updated Mar 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A75879 Issued in CA
Legal business name
EJD MEDICAL CORPORATION
Practice address
10801 Thornmint Rd
Suite 250
San Diego, CA 92127-2423
Phone
(858) 345-4887
Fax
(855) 450-0999
NPI assigned
Jun 18, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2015

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

Authorized official

Name
Richard Mantell, MD
Title
President
Phone
(858) 345-4887

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A39992 CA
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X A75879 CA Primary

Addresses

Primary practice location

10801 Thornmint Rd
Suite 250
San Diego, CA 92127-2423

Mailing address

10801 Thornmint Rd
Suite 250
San Diego, CA 92127-2423
Phone (858) 345-4887

Other names 1

  • RB Spine Center Doing business as

National Provider Directory

National Provider Directory

Locations

2815 W Sunset Blvd
Ste 201
Los Angeles, CA 90026
Phone (213) 413-8555

2835 Camino del Rio S
Ste 110
San Diego, CA 92108
Phone (619) 630-9153

16980 Via Tazon
Ste 100
San Diego, CA 92127
Phone (858) 345-4114

14402 Haynes St
Ste 101
Van Nuys, CA 91401
Phone (818) 781-7513

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1295962082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 THORNMINT RD",
            "address_2": "SUITE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921272423",
            "telephone_number": "858-345-4887",
            "fax_number": "855-450-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10801 THORNMINT RD",
            "address_2": "SUITE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921272423",
            "telephone_number": "858-345-4887",
            "fax_number": "855-450-0999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EJD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-18",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "MANTELL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-345-4887",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A39992",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A75879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RB Spine Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.