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949 Palm Avenue Imperial Beach CA 91932-1503 | |
| (619) 429-3733 | |
| (619) 429-6457 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 949 Palm Avenue, Imperial Beach, California |
| Authorized Official Name and Position | Constance Kirk (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6194295387 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 459 Imperial Beach CA 91933-0459 Ph: (619) 429-5387 | 949 Palm Avenue Imperial Beach CA 91932-1503 Ph: (619) 429-3733 |
| NPI Number | 1508028200 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508028200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (California) | Primary |
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