Organization
SOUTH BAY GERIATRIC AND INTERNAL MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUSHRIK KAISEY MD (PRESIDENT)
(619) 426-9731
Entity
Organization
Contact information
Practice address
340 4TH AVE, #9, CHULA VISTA, CA 91910-3813
(619) 426-9731
(619) 426-9733
Mailing address
PO BOX 92191, SAN DIEGO, CA 92191-0723
(619) 426-9731
(619) 426-9733
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
A72963
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A729631
—
CA
Enumeration date
01/31/2011
Last updated
08/02/2011
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