| Planned Parenthood Of The Pacific Southwest | |
|
2017 1st Ave Ste 100 San Diego CA 92101-9001 | |
| (619) 881-4516 | |
| Not Available |
| Full Name | Planned Parenthood Of The Pacific Southwest |
|---|---|
| Speciality | Clinic/Center |
| Location | 2017 1st Ave Ste 100, San Diego, California |
| Authorized Official Name and Position | Theresa Gonzales (DIRECTOR OF BILLING) |
| Authorized Official Contact | 6198814516 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Planned Parenthood Of The Pacific Southwest 1075 Camino Del Rio S San Diego CA 92108-3538 Ph: (619) 881-4516 | Planned Parenthood Of The Pacific Southwest 2017 1st Ave Ste 100 San Diego CA 92101-9001 Ph: (619) 881-4516 |
| NPI Number | 1497780480 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 3678719606 |
|---|---|
| Medicare Enrollment ID | O20130418000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497780480 | NPI | - | NPPES |
| CMM70420F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | (California) | Primary |
| 332900000X | Non-pharmacy Dispensing Site | 0507268 (California) | Secondary |
| Provider Name | Son Hong Nguyen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548332513 PECOS PAC ID: 9335194265 Enrollment ID: I20050314000915 |
| Provider Name | Kyle Christian Bukowski |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1912249004 PECOS PAC ID: 5092088179 Enrollment ID: I20170912002398 |
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