Wellhaven Primary Care | |
5555 Reservoir Dr Ste 303 San Diego CA 92120-5181 | |
(619) 752-2280 | |
Not Available |
Full Name | Wellhaven Primary Care |
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Speciality | Clinic/Center |
Location | 5555 Reservoir Dr Ste 303, San Diego, California |
Authorized Official Name and Position | Jillion T Harris (OWNER) |
Authorized Official Contact | 6197522280 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Wellhaven Primary Care 5663 Balboa Ave # 517 San Diego CA 92111-2705 Ph: () - | Wellhaven Primary Care 5555 Reservoir Dr Ste 303 San Diego CA 92120-5181 Ph: (619) 752-2280 |
NPI Number | 1306463542 |
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Provider Enumeration Date | 07/04/2020 |
Last Update Date | 07/04/2020 |
Medicare PECOS PAC ID | 2668898719 |
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Medicare Enrollment ID | O20200819002937 |
Identifier | Type | State | Issuer |
---|---|---|---|
1306463542 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Jillion T Harris |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1366768525 PECOS PAC ID: 9436393550 Enrollment ID: I20160719002797 |
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