Basic Information
| Provider Information | |||||||||
| NPI: | 1780869966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEIGHBORHOOD HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 N DATE ST | ||||||||
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| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920253413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607372035 | ||||||||
| FaxNumber: | 7605208314 | ||||||||
| Practice Location | |||||||||
| Address1: | 41715 WINCHESTER RD | ||||||||
| Address2: | SUITE 203 & 204 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925904854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516006300 | ||||||||
| FaxNumber: | 9516006306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | REAM | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7605208375 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | BCP70563G | 05 | CA | MEDICAID | HAP70563G | 05 | CA | MEDICAID | FHC70563G | 05 | CA | MEDICAID |