Organization
CASSIDY MEDICAL GROUP -PEDS
Active
Parent organization
CASSIDY MEDICAL GROUP INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CASSIDY MEDICAL GROUP INC.
Authorized official
JUDITH M KRUEGER (EXECUTIVE DIRECTOR)
(760) 630-5487
Entity
Organization
Contact information
Practice address
2067 W VISTA WAY STE 280, VISTA, CA 92083-6034
(760) 941-3630
(760) 941-1214
Mailing address
2067 W VISTA WAY STE 280, VISTA, CA 92083-6034
(760) 941-3630
(760) 941-1214
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W41833A
MEDICARE PTAN
—
Enumeration date
11/28/2006
Last updated
10/13/2010
Update your record
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