Organization
ADVANCED PEDIATRIC MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY JALAL SADRIEH M.D. (PRESIDENT AND OFFICER)
(858) 268-0702
Entity
Organization
Contact information
Practice address
5222 BALBOA AVE, SUITE 42, SAN DIEGO, CA 92117-6904
(858) 268-0702
(858) 268-0374
Mailing address
5222 BALBOA AVE, SUITE 42, SAN DIEGO, CA 92117-6991
(858) 268-0702
(858) 268-0374
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
A46462
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0071320
—
CA
Enumeration date
10/10/2006
Last updated
02/25/2013
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