# FIT ATHLETIC CLUB SAN DIEGO LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073047593
- **Authorized official:** CHAD SHAW (GENERAL MANAGER)
- **Authorized official phone:** (858) 675-4480

## Contact information

- **Practice address:** 350 10TH AVE, SAN DIEGO, CA 92101-7496
- **Practice address phone:** (619) 764-5348
- **Mailing address:** 350 10TH AVE, SAN DIEGO, CA 92101-7496
- **Mailing address phone:** (619) 764-5348

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2017
- **Last updated:** 04/12/2017