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Organization
THE S.P.O.R.T. INSTITUTE MEDICAL GROUP, INC.
Active
Organization
THE S.P.O.R.T. INSTITUTE MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM JOSEPH PREVITE D.O. (OWNER)
(858) 650-3030
Entity
Organization
Contact information
Practice address
7525 LINDA VISTA RD., SUITE C, SAN DIEGO, CA 92111
(858) 650-3030
(858) 650-3033
Mailing address
7525 LINDA VISTA RD., SUITE C, SAN DIEGO, CA 92111
(858) 650-3030
(858) 650-3033
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
20A5466
CA
Other
Enumeration date
12/10/2007
Last updated
08/11/2011
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