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Organization
FALLBROOK FAMILY HEALTH CLINIC, INC.
Active
Organization
FALLBROOK FAMILY HEALTH CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA R SHERIDAN D.O. (OSTEOPATHIC PHYSICIAN)
(760) 451-8815
Entity
Organization
Contact information
Practice address
577 E ELDER ST STE F, FALLBROOK, CA 92028-3079
(760) 451-8815
(760) 451-8798
Mailing address
577 E ELDER ST STE F, FALLBROOK, CA 92028-3079
(760) 451-8815
(760) 451-8798
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A12819
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20A12819
LICENSE ID NUMBER
CA
Enumeration date
05/05/2014
Last updated
05/05/2014
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