| Shoreline Medical Group Professional Corporation | |
|
769 Medical Center Ct # 303 Chula Vista CA 91911-6602 | |
| (619) 591-9001 | |
| (619) 591-9211 |
| Full Name | Shoreline Medical Group Professional Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 769 Medical Center Ct # 303, Chula Vista, California |
| Authorized Official Name and Position | Julie Roth (PHYSICIAN) |
| Authorized Official Contact | 6198042368 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoreline Medical Group Professional Corporation 769 Medical Center Ct # 303 Chula Vista CA 91911-6602 Ph: (619) 591-9001 | Shoreline Medical Group Professional Corporation 769 Medical Center Ct # 303 Chula Vista CA 91911-6602 Ph: (619) 591-9001 |
| NPI Number | 1225860232 |
|---|---|
| Provider Enumeration Date | 08/19/2024 |
| Last Update Date | 02/28/2025 |
| Medicare PECOS PAC ID | 2961929161 |
|---|---|
| Medicare Enrollment ID | O20250512000889 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225860232 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Julie A Roth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720091572 PECOS PAC ID: 2860517752 Enrollment ID: I20100915001053 |
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