Unknown Individual – Addiction Medicine (Family Medicine) Physician, NPI 1003969031
Excluded from federal healthcare programs (Medicare/Medicaid)
This provider is listed on the OIG List of Excluded Individuals/Entities (LEIE). Exclusion effective: 2009-12-20. Reason: License revocation, suspension, or surrender.
Addiction Medicine (Family Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Balboa Avenue, Clairemont, San Diego, San Diego County, California, 92117, United States
SAN DIEGO, CA 921094735
Phone: (858) 274-6633
Type: Location
14233, Half Moon Bay Drive, Del Mar Heights, Del Mar, San Diego County, California, 92014, United States
DEL MAR, CA 920142908
Phone: (858) 274-6633
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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.
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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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 92109)
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