Organization
AMIGO MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SALLY ANDERSON MONAHAN (SECRETARY TREASURER)
(619) 427-5053
Entity
Organization
Contact information
Practice address
386 E H ST, SUITE 210, CHULA VISTA, CA 91910-7485
(619) 427-5053
(619) 427-1437
Mailing address
386 E H ST, SUITE 210, CHULA VISTA, CA 91910-7485
(619) 427-5053
(619) 427-1437
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
FNP 4774
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0046550
—
CA
Enumeration date
04/17/2006
Last updated
08/22/2020
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