| Sycuan Tribal Government | |
|
5442 Sycuan Rd El Cajon CA 92019-1816 | |
| (619) 445-0707 | |
| (619) 445-9764 |
| Full Name | Sycuan Tribal Government |
|---|---|
| Speciality | Clinic/Center |
| Location | 5442 Sycuan Rd, El Cajon, California |
| Authorized Official Name and Position | Daniel L. Barbara (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 6194450707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sycuan Tribal Government 5442 Sycuan Rd El Cajon CA 92019-1816 Ph: (619) 445-0707 | Sycuan Tribal Government 5442 Sycuan Rd El Cajon CA 92019-1816 Ph: (619) 445-0707 |
| NPI Number | 1427197078 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 01/26/2018 |
| Medicare PECOS PAC ID | 5698795813 |
|---|---|
| Medicare Enrollment ID | O20051202000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427197078 | NPI | - | NPPES |
| 1427197078 | Medicaid | CA | |
| ZZZ50681Z | Other | CA | BLUE CROSS |
| 54220ZZZ50681Z | Other | CA | BLUE SHIELD OF CALIFORNIA |
| THP70066F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Arjun N Reddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730132457 PECOS PAC ID: 7214922681 Enrollment ID: I20040415000993 |
| Provider Name | Wendy S Dengerink |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104822022 PECOS PAC ID: 4587645569 Enrollment ID: I20050923000410 |
| Provider Name | Melchior Peter Vallone |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1093998965 PECOS PAC ID: 2365565405 Enrollment ID: I20101112000202 |
| Provider Name | Teresa M Mogielnicki |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043202765 PECOS PAC ID: 4981892874 Enrollment ID: I20101220000140 |
| Provider Name | Donald Weiss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780770560 PECOS PAC ID: 8426246323 Enrollment ID: I20140611002350 |
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