Individual
PHILIP GEORGE BROECKEL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9888 GENESEE AVE, LA JOLLA, CA 92037-1205
(858) 626-6151
Mailing address
3198 AVENIDA HACIENDA, ESCONDIDO, CA 92029-7925
(760) 715-5572
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
G37332
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MEDICAL LICENSE
G37332
CA
Enumeration date
11/30/2006
Last updated
10/19/2010
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