Provider Demographics
NPI:1174706345
Name:SOUTH BAY INTERNAL MEDICINE AND FAMILY PRACTICE GROUP INC
Entity type:Organization
Organization Name:SOUTH BAY INTERNAL MEDICINE AND FAMILY PRACTICE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOLI
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-426-4546
Mailing Address - Street 1:374 H ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5547
Mailing Address - Country:US
Mailing Address - Phone:619-426-4546
Mailing Address - Fax:619-426-7198
Practice Address - Street 1:374 H ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5547
Practice Address - Country:US
Practice Address - Phone:619-426-4546
Practice Address - Fax:619-426-7198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG98162207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty