Provider Demographics
NPI:1699985812
Name:MULTICULTURAL PRIMARY CARE MEDICAL GROUP
Entity type:Organization
Organization Name:MULTICULTURAL PRIMARY CARE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-291-1987
Mailing Address - Street 1:3465 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3905
Mailing Address - Country:US
Mailing Address - Phone:619-684-4980
Mailing Address - Fax:
Practice Address - Street 1:3465 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3905
Practice Address - Country:US
Practice Address - Phone:619-684-4980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty