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Organization
MEDAID CENTER
Active
Organization
MEDAID CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK C HENDERSON (CEO)
(858) 405-9653
Entity
Organization
Contact information
Practice address
5580 LA JOLLA BLVD, SUITE 611, LA JOLLA, CA 92037-7651
(858) 405-9653
Mailing address
5580 LA JOLLA BLVD, SUITE 611, LA JOLLA, CA 92037-7651
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
C50464
CA
Other
Enumeration date
05/22/2009
Last updated
08/15/2009
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