| |
343 E Main St Ste 101 El Cajon CA 92020-3942 | |
(619) 447-6001 | |
(619) 447-6096 |
Full Name | |
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Speciality | Family Medicine |
Location | 343 E Main St Ste 101, El Cajon, California |
Authorized Official Name and Position | Charlene Anne Wulff (OFFICE MANAGER) |
Authorized Official Contact | 6193127049 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1626 El Cajon CA 92022-1626 Ph: (619) 447-6001 | 343 E Main St Ste 101 El Cajon CA 92020-3942 Ph: (619) 447-6001 |
NPI Number | 1396082517 |
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Provider Enumeration Date | 01/08/2013 |
Last Update Date | 01/08/2025 |
Medicare PECOS PAC ID | 4587818083 |
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Medicare Enrollment ID | O20130211000168 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396082517 | NPI | - | NPPES |
1609194570 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | G65104 (California) | Primary |
Provider Name | Fereshteh Jahanpanah |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1518034115 PECOS PAC ID: 0244227791 Enrollment ID: I20040427001636 |
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