Organization
LEGACY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RALPH HERNANDEZ (EXECUTIVE DIRECTOR)
(619) 733-5192
Entity
Organization
Contact information
Practice address
292 EUCLID AVE STE 210, SAN DIEGO, CA 92114-3629
(619) 262-2224
Mailing address
292 EUCLID AVE STE 210, SAN DIEGO, CA 92114-3629
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2018
Last updated
02/20/2018
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