| N/a | |
|
769 Medical Center Ct Suite 203 Chula Vista CA 91911-6602 | |
| (619) 421-3313 | |
| (619) 421-3315 |
| Full Name | N/a |
|---|---|
| Speciality | Internal Medicine |
| Location | 769 Medical Center Ct, Chula Vista, California |
| Authorized Official Name and Position | Jeannette Del Valle (PRESIDENT) |
| Authorized Official Contact | 6194213313 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a Po Box 568 Muncie IN 47308-0568 Ph: (765) 284-0493 | N/a 769 Medical Center Ct Suite 203 Chula Vista CA 91911-6602 Ph: (619) 421-3313 |
| NPI Number | 1689803215 |
|---|---|
| Provider Enumeration Date | 07/02/2009 |
| Last Update Date | 08/06/2014 |
| Medicare PECOS PAC ID | 7517012115 |
|---|---|
| Medicare Enrollment ID | O20090903000380 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689803215 | NPI | - | NPPES |
| 00A426600 | Medicaid | CA | |
| 1952370074 | Other | CA | TYPE I NPI |
| WA42660G | Other | CA | MEDICARE ID-TYPE UNSPECIFIED |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A42660 (California) | Primary |
| Provider Name | Jeannette Delvalle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952370074 PECOS PAC ID: 4183779788 Enrollment ID: I20090903000351 |
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