Basic Information
| Provider Information | |||||||||
| NPI: | 1932144136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTEREY COUNTY INFECTIOUS DISEASE COUNSULTANTS, INC A MED CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1033 LOS PALOS DR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317572058 | ||||||||
| FaxNumber: | 8317580311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 LOS PALOS DR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317572058 | ||||||||
| FaxNumber: | 8317580311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | RADNER | ||||||||
| AuthorizedOfficialFirstName: | ALLEN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8316468286 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.