Basic Information
| Provider Information | |||||||||
| NPI: | 1689707739 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS FOR FITNESS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3439 | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919443439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194641165 | ||||||||
| FaxNumber: | 6194641157 | ||||||||
| Practice Location | |||||||||
| Address1: | 5550 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921052307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195010122 | ||||||||
| FaxNumber: | 6194641157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 10/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | CASTILLO | ||||||||
| AuthorizedOfficialFirstName: | GUILLERMO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6195010122 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.