Organization
EAST COUNTY DERMATOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOSEPH THOENE M.D. (PRESIDENT)
(619) 442-4468
Entity
Organization
Contact information
Practice address
514 S MAGNOLIA AVE, EL CAJON, CA 92020-6011
(619) 442-4468
(619) 442-6432
Mailing address
514 S MAGNOLIA AVE, EL CAJON, CA 92020-6011
(619) 442-4468
(619) 442-6432
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G25265
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0017820
—
CA
05
—
GR0017821
—
CA
Enumeration date
07/28/2006
Last updated
06/04/2015
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