South Bay Internal Medicine and Family Practice

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

G84802 Issued in CA

Legal business name

SOUTH BAY INTERNAL MEDICINE AND FAMILY PRACTICE

Practice address

374 H Street
202
San Diego, CA 92107

Phone

(619) 426-4546

NPI assigned

Jan 6, 2012

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Sr Director Ops

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Tax ID family

South Bay Internal Med Family Prac GRP2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• South Bay Internal Medicine and Family Practice Group Inc

  • Internal Medicine Physician
  • Chula Vista, CA
  • NPI 1174706345
  NPD tax ID

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1386914422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 H STREET",
            "address_2": "202",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92107",
            "telephone_number": "619-426-4546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY INTERNAL MEDICINE AND FAMILY PRACTICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2012-01-06",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR DIRECTOR OPS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G84802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Source Empowered Wellness
• Celesta Carla Sousa, BS
• John-Anthony Sousa
• South America Medical Network Inc
• South Bay Comprehensive Primary Care a Medical Corp
• South Coast Gynecologic Oncology, Inc
• South Coast Home Health, Inc.
• South Coast Medical Supply LLC
• Aryn South
• Lauren R South, LPCC

• Non-Pharmacy Dispensing Site in San Diego, CA
• Providers in San Diego, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.