Provider Demographics
NPI:1043497316
Name:ADEMA FAMILY MEDICINE, INC
Entity type:Organization
Organization Name:ADEMA FAMILY MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADEMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-596-5445
Mailing Address - Street 1:10201 MISSION GORGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3026
Mailing Address - Country:US
Mailing Address - Phone:619-596-5445
Mailing Address - Fax:619-596-6923
Practice Address - Street 1:10201 MISSION GORGE RD STE C
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3026
Practice Address - Country:US
Practice Address - Phone:619-596-5445
Practice Address - Fax:619-596-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2OA6239OtherSTATE LICENSE CA
CA2OA6239OtherSTATE LICENSE CA