| NPI | 1548288574 |
|---|---|
| Former Legal Business Name | SPENCER MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | CORVIN KELLY Director/Officer 760-568-4544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A83821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26074) |
| 207R00000X Internal Medicine (Licence: CA C29564) | |
| 225100000X Physical Therapist (Licence: CA PT19355) | |
| 208D00000X General Practice (Licence: CA A28654) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-03-15 |