Organization
ADVANCED MD MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DIRK KANCILIA (ADMINISTRATION)
(858) 345-4887
Entity
Organization
Contact information
Practice address
2878 CAMINO DEL RIO S STE 404, SAN DIEGO, CA 92108-3848
(858) 345-4887
Mailing address
235 W WASHINGTON AVE, A55, ESCONDIDO, CA 92025-2634
(858) 345-4887
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G87969
CA
Other
Enumeration date
12/18/2016
Last updated
12/18/2016
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