Organization
CASSIDY MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M BENNETT M.D. (PRESIDENT)
(760) 630-5487
Entity
Organization
Contact information
Practice address
145 THUNDER DR, VISTA, CA 92083-6010
(760) 630-5487
(760) 630-2558
Mailing address
145 THUNDER DR, VISTA, CA 92083-6010
(760) 630-5487
(760) 630-2558
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3000
NEIC SITE ID, NSF BA0-7
CA
01
—
366026600
DEPARTMENT OF LABOR ID
CA
01
—
CAME25
UNIVERSAL ID
CA
05
—
GR0060600
—
CA
01
—
ZZZ59748Z
BLUE CROSS BLUE SHIELD ID
CA
Enumeration date
11/28/2006
Last updated
06/09/2010
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