Provider Demographics
NPI:1679952337
Name:SYNERGY SPECIALISTS MEDICAL GROUP
Entity type:Organization
Organization Name:SYNERGY SPECIALISTS MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-571-9500
Mailing Address - Street 1:4445 EASGATE MALL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1979
Mailing Address - Country:US
Mailing Address - Phone:858-412-6080
Mailing Address - Fax:858-412-6376
Practice Address - Street 1:9834 GENESEE AVE STE 228
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1215
Practice Address - Country:US
Practice Address - Phone:858-455-9942
Practice Address - Fax:858-455-6473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYNERGY SPECIALISTS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-27
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty