Gary Vandenberg,Jr., M.D.,Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

C33053 Issued in CA

Legal business name

GARY VANDENBERG,JR., M.D.,INC.

Practice address

9834 Genesee Ave Ste 326
La Jolla, CA 92037-1216

Phone

(858) 453-3813

Fax

(858) 453-1727

NPI assigned

Sep 28, 2017

Organization subpart

No

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

Authorized official

Name

Gary Vandenberg, M.D.

Title

President

Phone

(858) 453-3813

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1506556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306355714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9834 GENESEE AVE STE 326",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371216",
            "telephone_number": "858-453-3813",
            "fax_number": "858-453-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9834 GENESEE AVE STE 326",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371216",
            "telephone_number": "858-453-3813",
            "fax_number": "858-453-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY VANDENBERG,JR., M.D.,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "VANDENBERG",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-453-3813",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "C33053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M.D.",
            "identifier": "C33053",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pranav Sandilya Garimella, M.D.
• Ned W. Garrigues, M.D.
• Jennifer E Garrow, N.P.
• Melissa Garth, APN
• Cathy-Ann H. Garvey, R.D.
• Morgan Elizabeth Gary, PA
• Vicente G Garzo-Toro, MD
• Judith Ann Gaspar, FNP
• Gavin J. Miller, DDS, Inc.
• Michael Jay Gawler, COTA

• Primary Care Clinic/Center in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.