| Clairemont Family Medical Clinic | |
|
3737 Moraga Ave Ste B408 San Diego CA 92117-5364 | |
| (858) 292-8885 | |
| (858) 292-0688 |
| Full Name | Clairemont Family Medical Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 3737 Moraga Ave, San Diego, California |
| Authorized Official Name and Position | Gary Kenneth Boone (PRESIDENT) |
| Authorized Official Contact | 8582928885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clairemont Family Medical Clinic 3737 Moraga Ave Ste B408 San Diego CA 92117-5364 Ph: (858) 292-8885 | Clairemont Family Medical Clinic 3737 Moraga Ave Ste B408 San Diego CA 92117-5364 Ph: (858) 292-8885 |
| NPI Number | 1932257193 |
|---|---|
| Provider Enumeration Date | 01/06/2007 |
| Last Update Date | 11/12/2020 |
| Medicare PECOS PAC ID | 5193755254 |
|---|---|
| Medicare Enrollment ID | O20050817001223 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932257193 | NPI | - | NPPES |
| 00G319680 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | G31968 (California) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Gary K Boone |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1073543781 PECOS PAC ID: 6002846169 Enrollment ID: I20120627000425 |
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