PROGRESSIVE MEDICAL SPECIALISTS LLC


Address: 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4677
Phone: 6192864600

PROGRESSIVE MEDICAL SPECIALISTS LLC (NPI# 1932251550) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932251550
Entity Type Organization
Organization Name PROGRESSIVE MEDICAL SPECIALISTS LLC
Practice Address 4974 El Cajon Blvd
Suite A
San Diego
CA 92115-4677
Practice Telephone 6192864600
Practice Fax Number 3192860060
Mailing Telephone 6192864600
Mailing Fax Number 3192860060
Enumeration Date 2007-01-16
Last Update Date 2007-11-29
Authorized Official Name MR. TIMOTHY BOYLAN (DIRECTOR)
Authorized Official Telephone 6192864600
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM2800X Clinic/Center
Specialization: Methadone Clinic
37-19 CA Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
CA MEDI-CAL 8545 01

Office Location

Street Address 4974 EL CAJON BLVD
SUITE A
City SAN DIEGO
State CA
Zip Code 92115-4677

Providers in the same location

NPI Name Taxonomy Address Enumeration
1548806623 April J Greenwood Licensed Vocational Nurse 4974 El Cajon Blvd, San Diego, CA 92115-4654 2019-11-22
1982173266 Theresa Maria Drobina Licensed Vocational Nurse 4974 El Cajon Blvd, San Diego, CA 92115-4654 2018-11-16
1306371083 Kelly Nordstrom Licensed Vocational Nurse 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 2017-05-01
1992237150 Saleem Malik Counselor 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 2017-03-28
1861942104 Kirk Lamar Counselor 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 2016-10-11
1285087718 Lois Fossing Licensed Practical Nurse 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4677 2016-07-20
1063885010 Susan Babcock Counselor 4974 El Cajon Blvd, San Diego, CA 92115-4654 2015-11-12
1477925337 Patty Reyes Licensed Practical Nurse 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 2015-10-30
1295104586 Danalee Delossantos Licensed Vocational Nurse 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4677 2015-09-17
1205205572 Joan Fernandez Licensed Vocational Nurse 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4677 2015-09-17
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1790313922 Mayra Ailed Bugarin Student in an Organized Health Care Education/Training Program City Heights Family Health Center 5454, El Cajon Blvd, San Diego, CA 92115 2020-04-01
1093369878 Chang Liu Counselor 3539 College Avenue, San Diego, CA 92115 2019-07-30
1689238560 Donia Ahadian Student in an Organized Health Care Education/Training Program City Heights Family Health Center, 5454 El Cajon Blvd, San Diego, CA 92115 2019-04-26
1780157859 James Michael Sites Military Health Care Provider Uss Shoup Ddg 86, San Diego, CA 92115 2019-01-10
1780163006 Marcos Luis Sandoval Case Manager/Care Coordinator 6224 El Cajon Blvd, Suite 17, San Diego, CA 92115 2018-08-08
1437651981 Phyllis Lynette Pryor Licensed Vocational Nurse 4974 El Cajon Blvd Suite A, San Diego, CA 92115 2018-03-01
1982125605 Ellen Medical Transport Non-emergency Medical Transport (VAN) 4587 Winona Ave #5, San Diego, CA 92115 2017-07-03
1992225296 P'okot LLC Non-emergency Medical Transport (VAN) 5511 Adelaide Ave, 26, San Diego, CA 92115 2017-06-27
1578019840 Alfred Zygmunt Nowak Specialist/Technologist 6663 Reservoir Ln, San Diego, CA 92115 2016-08-28
1639534183 Kalkaal Financial Enterprise, LLC. Non-emergency Medical Transport (VAN) 5055 Collwood Blvd., Unit 108, San Diego, CA 92115 2015-12-29
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Taxonomy Information

Taxonomy Code 261QM2800X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Methadone Clinic

Taxonomy Definition

An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1679802789 Crc Health Clinic/Center 7020 Friars Road, San Diego, CA 92108 2009-12-18
1609997865 Crc Health Group, Inc Clinic/Center 7020 Friars Rd, San Diego, CA 92108-1126 2007-04-03
1780153882 Akua Behavioral Health, Inc Clinic/Center 2754 Imperial Ave, San Diego, CA 92102-4031 2018-11-19
1477998136 Juan Angel Graciano Clinic/Center 3940 Home Ave, San Diego, CA 92105-5952 2013-05-07
1487097960 San Diego Treatment Services Clinic/Center 7020 Friars Rd, San Diego, CA 92108-1126 2013-04-15
1285986430 Crc Home Avenue Clinic Clinic/Center 3940 Home Ave, San Diego, CA 92105-5952 2012-10-12
1326379926 Armt Medical Specialists, Inc Clinic/Center 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4654 2010-01-21
1457533747 Progressive Medical Specialists Clinic/Center 4974 El Cajon Blvd, Suite A, San Diego, CA 92115-4677 2007-11-29
1285821389 Duangtavan Sourivong Clinic/Center 3940 Home Ave, San Diego, CA 92105-5952 2007-10-02
1437372778 Crc Health Clinic/Center 7020 Friars Rd, San Diego, CA 92108-1126 2007-04-11
Find all providers in SAN DIEGO

Competitor

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City SAN DIEGO
Zip Code 92115

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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