| San Diego Prep Inc | |
|
1665 Union St Ste A San Diego CA 92101-2906 | |
| (619) 736-1772 | |
| (619) 373-9206 |
| Full Name | San Diego Prep Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1665 Union St Ste A, San Diego, California |
| Authorized Official Name and Position | Anthony Fam (COO) |
| Authorized Official Contact | 5595798343 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| San Diego Prep Inc 1665 Union St Ste A San Diego CA 92101-2906 Ph: (559) 579-8343 | San Diego Prep Inc 1665 Union St Ste A San Diego CA 92101-2906 Ph: (619) 736-1772 |
| NPI Number | 1144916248 |
|---|---|
| Provider Enumeration Date | 04/12/2023 |
| Last Update Date | 04/12/2023 |
| Medicare PECOS PAC ID | 0042674004 |
|---|---|
| Medicare Enrollment ID | O20230911001656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144916248 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Anthony Fam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114245800 PECOS PAC ID: 8729214127 Enrollment ID: I20190605000164 |
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