Healthcare Provider Details

I. General information

NPI: 1598686966
Provider Name (Legal Business Name): EASTLAKE URGENT CARE A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2436 FENTON ST BLDG 6
CHULA VISTA CA
91914-3516
US

IV. Provider business mailing address

2436 FENTON ST BLDG 6
CHULA VISTA CA
91914-3516
US

V. Phone/Fax

Practice location:
  • Phone: 619-789-7385
  • Fax:
Mailing address:
  • Phone: 619-789-7385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAREK HASSANEIN
Title or Position: DIRECTOR
Credential: MD
Phone: 619-990-1698