Poway Medical Clinic, Incorporated

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

POWAY MEDICAL CLINIC, INCORPORATED

Practice address

13525 Midland Rd
Poway, CA 92064-4771

Phone

(858) 486-9100

Fax

(858) 486-9101

NPI assigned

Oct 16, 2009

Organization subpart

No

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

Authorized official

Name

David Thygeson

Title

Chief Financial Officer

Phone

(858) 486-9100

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Charlotte Leslie Brandt

  • Internal Medicine Physician
  • Poway, CA
  • NPI 1528664604
  NPD (past)
• Jazel Ruivivar Sambo, NP

  • Nurse Practitioner
  • Carlsbad, CA
  • NPI 1043860844
  NPD (past)

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

{
    "created_epoch": "1255651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1861727372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13525 MIDLAND RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644771",
            "telephone_number": "858-486-9100",
            "fax_number": "858-486-9101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13525 MIDLAND RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644771",
            "telephone_number": "858-486-9100",
            "fax_number": "858-486-9101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POWAY MEDICAL CLINIC, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-16",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "THYGESON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "858-486-9100"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Poway Ca Multi Specialty ASC LLC
• Poway Emergency Physicians, Inc
• Poway Gardens Memory Care LLC
• Poway Hospitalist Medical Group, Inc
• Poway Intensivist Medical Group, Inc
• Poway Pharmacy LLC
• Poway Surgery Center
• Heather Preber, D.M.D.
• Precision Orthopedics and Sports Medicine
• Larry Alan Presant, MD

• Primary Care Clinic/Center in Poway, CA
• Providers in Poway, 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 Oct 16, 2009; 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.