Provider Demographics
NPI:1871785899
Name:SO-CAL PROVIDERS MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:SO-CAL PROVIDERS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:BUEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-455-6330
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:STE 560
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-455-6330
Mailing Address - Fax:858-455-5408
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:STE 560
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-455-6330
Practice Address - Fax:858-455-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty