Unknown Individual – Family Medicine Physician, NPI 1790749208

Unknown Individual is a healthcare provider. based in Chula vista, California. specializing in Family Medicine Physician. They hold a License No. A66649 (CA). The NPI Number for Unknown Individual is 1790749208

Main info

Organization
Inactive
32 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790749208
Phone
(619) 427-3361
Address
480 4TH AVE
Deactivation Date
17 February 2025

Doctor Profile

Medical School Name
UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
Secondary Phone
6194273361
Graduation Year
1994 (32 years ago)
PAC ID
3870690621
Group Practice PAC ID
0345347191
Professional Enrollment ID
I20070514000258
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 480, 4th Avenue, Chula Vista, San Diego County, California, 91910, United States

    SUITE 202

    CHULA VISTA, CA 919104410

    Phone: (619) 427-3361

    Fax: (619) 427-6821

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 29 Open Payments records for all available years, with a total value of $615.

Total Amount is formed as General ($615) + Research ($0) + Ownership ($0) = $615.

Last reported payment date: 2024-10-08 • Largest payer in this snapshot: ABBVIE INC. ($134).

Total Amount

$615

General + Research + Ownership

Payments

29

Total payment records

General Amount

$615

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-08

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes25592$0
99214Established patient office or other outpatient visit, 30-39 minutes3124$0
99212Established patient office or other outpatient visit, 10-19 minutes2921$0
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit2020$0
93000Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report1818$0
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Insurance plans in this area (ZIP 91910)

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Provider's Procedures

Unknown Individual performs procedures in Family Medicine Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
FAMILY MEDICINECA90670Pneumococcal vaccine for injection into muscle2424

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0345347191View full group profile
NameSpecialtyState
Osteopathic Manipulative Medicine, Family PracticeCA
Family PracticeCA
Family PracticeCA
Family PracticeCA
Family PracticeCA
Family PracticeCA
Family PracticeCA
Family PracticeCA
E N D O C R I N O L O G YOR

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1790749208 is assigned to Unknown Individual under the national enumeration system.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Family Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Chula Vista, California for Unknown Individual; download NPPES for the complete set.
What if Chula Vista, California seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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