Healthcare Provider Details

I. General information

NPI: 1679712780
Provider Name (Legal Business Name): FLORA I DANQUE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 EL CAJON BLVD SUITE N322
LA MESA CA
91942-6719
US

IV. Provider business mailing address

7918 EL CAJON BLVD SUITE N322
LA MESA CA
91942-6719
US

V. Phone/Fax

Practice location:
  • Phone: 619-441-1027
  • Fax: 619-741-9422
Mailing address:
  • Phone: 619-441-1027
  • Fax: 619-741-9422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA62874
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA62874
License Number StateCA

VIII. Authorized Official

Name: DR. FLORA ISHIHARA DANQUE
Title or Position: OWNER
Credential: MD
Phone: 619-441-1027