| Psychiatric Consultants Of San Diego Medical Group Inc | |
|
7850 Vista Hill Ave San Diego CA 92123-2717 | |
| (838) 694-8399 | |
| Not Available |
| Full Name | Psychiatric Consultants Of San Diego Medical Group Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 7850 Vista Hill Ave, San Diego, California |
| Authorized Official Name and Position | Raymond A. Fidaleo (OWNER) |
| Authorized Official Contact | 8586948399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Consultants Of San Diego Medical Group Inc Po Box 34190 San Diego CA 92163-4190 Ph: (619) 680-4211 | Psychiatric Consultants Of San Diego Medical Group Inc 7850 Vista Hill Ave San Diego CA 92123-2717 Ph: (838) 694-8399 |
| NPI Number | 1033390869 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 05/28/2009 |
| Medicare PECOS PAC ID | 2860542198 |
|---|---|
| Medicare Enrollment ID | O20090609000142 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033390869 | NPI | - | NPPES |
| 00G117490 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G11749 (California) | Primary |
| Provider Name | Raymond A Fidaleo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548379225 PECOS PAC ID: 3870662349 Enrollment ID: I20080523000343 |
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