NPIMap

Organization Active NPI

San Marcos Medical Group Inc.

  • Clinical Medical Laboratory
  • San Bernardino, CA
National Provider Identifier
1447396593
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
LAB 69268F Issued in CA
Legal business name
SAN MARCOS MEDICAL GROUP INC.
Practice address
1574 W Base Line St Ste 107
San Bernardino, CA 92411-1736
Phone
(909) 386-1880
Fax
(909) 386-1882
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Azer Rezk
Title
Administrater
Phone
(909) 376-7715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X LAB 69268F CA Primary

Addresses

Primary practice location

1574 W Base Line St Ste 107
San Bernardino, CA 92411-1736

Mailing address

1574 W Base Line St Ste 107
San Bernardino, CA 92411-1736
Phone (909) 386-1880

Other identifiers 1

IdentifierTypeStateIssuer
LAB69268FMedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Metropolitan Family Medical Clinic8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447396593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1574 W BASE LINE ST STE 107",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111736",
            "telephone_number": "909-386-1880",
            "fax_number": "909-386-1882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1574 W BASE LINE ST STE 107",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111736",
            "telephone_number": "909-386-1880",
            "fax_number": "909-386-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MARCOS MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "REZK",
        "authorized_official_first_name": "AZER",
        "authorized_official_title_or_position": "ADMINISTRATER",
        "authorized_official_telephone_number": "909-376-7715"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "LAB 69268F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB69268F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • 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.