| Infectious Diseases Physicians Of San Diego, Inc. | |
|
4136 Bachman Pl San Diego CA 92103-2028 | |
| (619) 298-1443 | |
| (619) 298-6188 |
| Full Name | Infectious Diseases Physicians Of San Diego, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4136 Bachman Pl, San Diego, California |
| Authorized Official Name and Position | Tammy Pappas (OFFICE MANAGER) |
| Authorized Official Contact | 6192981443 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infectious Diseases Physicians Of San Diego, Inc. 4136 Bachman Pl San Diego CA 92103-2028 Ph: (619) 298-1443 | Infectious Diseases Physicians Of San Diego, Inc. 4136 Bachman Pl San Diego CA 92103-2028 Ph: (619) 298-1443 |
| NPI Number | 1073547667 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 05/20/2022 |
| Medicare PECOS PAC ID | 1355234071 |
|---|---|
| Medicare Enrollment ID | O20040205001256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073547667 | NPI | - | NPPES |
| 00G418940 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | G41894 (California) | Primary |
| Provider Name | Gonzalo Ballon Landa |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1326266081 PECOS PAC ID: 2264325885 Enrollment ID: I20110309000678 |
| Provider Name | Laya M Reddy |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1861928921 PECOS PAC ID: 3870912421 Enrollment ID: I20200930002634 |
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