Basic Information
| Provider Information | |||||||||
| NPI: | 1962175836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ON CALL SPECIALISTS MEDICAL GROUP OF SAN DIEGO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 WASHINGTON ST STE 841 | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193596600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4077 FIFTH AVE | ||||||||
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| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192948111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2021 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | CRACROFT | ||||||||
| AuthorizedOfficialFirstName: | LAURANCE | ||||||||
| AuthorizedOfficialMiddleName: | DAVIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6193596600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2084P0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 213E00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | 174400000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.