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Organization
CASSIDY MEDICAL GROUP - SW
Active
Organization
CASSIDY MEDICAL GROUP - SW
Active
Parent organization
CASSIDY MEDICAL GROUP INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CASSIDY MEDICAL GROUP INC.
Authorized official
JUDITH M KRUEGER (EXECUTIVE DIRECTOR)
(760) 630-5487
Entity
Organization
Contact information
Practice address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 630-3562
(760) 630-2559
Mailing address
2095 W VISTA WAY STE 218, VISTA, CA 92083-6029
(760) 630-3562
(760) 630-2559
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3016
NEIC SITE ID, NSF BA0-7
CA
05
—
GROO60602
—
CA
Enumeration date
11/29/2006
Last updated
10/13/2010
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