Organization
CASSIDY MEDICAL GROUP - OB-GYN
Active
Parent organization
CASSIDY MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
CASSIDY MEDICAL GROUP
Authorized official
JUDITH M KRUEGER (EXECUTIVE DIRECTOR)
(760) 630-5487
Entity
Organization
Contact information
Practice address
145 THUNDER DR, VISTA, CA 92083-6010
(760) 941-1440
(760) 630-5477
Mailing address
145 THUNDER DR, VISTA, CA 92083-6010
(760) 941-1440
(760) 630-5477
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3019
NEIC SITE ID, NSF BAO-7
CA
05
—
GR0060601
—
CA
Enumeration date
11/30/2006
Last updated
10/14/2010
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