Organization
ESCONDIDO CARDIOLOGY ASSOCIATES MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN H DETWILER M.D. (PRESIDENT)
(760) 743-0546
Entity
Organization
Contact information
Practice address
488 E VALLEY PKWY, SUITE 201, ESCONDIDO, CA 92025-3363
(760) 743-0546
(760) 743-8837
Mailing address
488 E VALLEY PKWY, SUITE 201, ESCONDIDO, CA 92025-3363
(760) 743-0546
(760) 743-8837
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CU0135
RR MEDICARE
—
01
—
ZZZ70943Z
BLUE SHIELD
CA
05
—
ZZZ70943Z
—
CA
Enumeration date
02/06/2006
Last updated
08/30/2012
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