Organization
GARY VANDENBERG,JR., M.D.,INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY VANDENBERG M.D. (PRESIDENT)
(858) 453-3813
Entity
Organization
Contact information
Practice address
9834 GENESEE AVE STE 326, LA JOLLA, CA 92037-1216
(858) 453-3813
(858) 453-1727
Mailing address
9834 GENESEE AVE STE 326, LA JOLLA, CA 92037-1216
(858) 453-3813
(858) 453-1727
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
C33053
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C33053
M.D.
CA
Enumeration date
09/28/2017
Last updated
07/21/2022
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