# MIRA MESA BUSINESS GROUP LLC

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

## Provider details

- **NPI number:** 1750829487
- **Authorized official:** DAVIS DUONG (SECRETARY)
- **Authorized official phone:** (858) 380-7530

## Contact information

- **Practice address:** 9460 MIRA MESA BLVD, SUITE L, SAN DIEGO, CA 92126-4851
- **Practice address phone:** (858) 863-7246
- **Practice address fax:** (858) 252-2650
- **Mailing address:** 9460 MIRA MESA BLVD, SUITE L, SAN DIEGO, CA 92126-4851
- **Mailing address phone:** (858) 863-7246
- **Mailing address fax:** (858) 252-2650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2017
- **Last updated:** 02/01/2017