Provider Demographics
NPI:1053809244
Name:THRIVE MEDICAL SPECIALISTS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:THRIVE MEDICAL SPECIALISTS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-435-5400
Mailing Address - Street 1:158 C AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118
Mailing Address - Country:US
Mailing Address - Phone:619-435-5400
Mailing Address - Fax:619-435-5401
Practice Address - Street 1:322 N NEVADA ST.
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054
Practice Address - Country:US
Practice Address - Phone:760-284-7483
Practice Address - Fax:844-926-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty