OrganizationGastric Banding Medical Group Inc(<Unavail>)SpecialistOther Service ProvidersPractice Address8705 Complex Dr, San Diego, CA 92123-1401(858) 715-1822PECOS EnrollmentBased on the most recent information from CMS, provider Gastric Banding Medical Group Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1841675386Provider TypeOrganizationFull NameGastric Banding Medical Group IncOther Name<Unavail>SubpartNoEnumeration Date7/27/2015Last Updated7/27/2015Contact InformationPractice LocationPractice Address8705 Complex Dr, San Diego, CA 92123-1401Phone(858) 715-1822Fax(858) 974-7245Mailing LocationMailing Address8705 Complex Dr, San Diego, CA 92123-1401Phone(858) 715-1822Fax(858) 974-7245Authorized OfficialNameGertsch, Ronald Leroy (Medical Director)Phone(858) 715-1822Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseC35744CaliforniaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseA35980CaliforniaCode174400000XDescriptionSpecialistOther Service ProvidersLicenseA67078CaliforniaProvider IdentifiersIDDescriptionIssuerID1124080015DescriptionOtherIssuerNPIID1891877056DescriptionOtherIssuerNPIID1043356033DescriptionOtherIssuerNPI