Healthcare Provider Details

I. General information

NPI: 1841342243
Provider Name (Legal Business Name): CLARA LUCY POLAK, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 35TH ST STE 101
NATIONAL CITY CA
91950-7926
US

IV. Provider business mailing address

480 4TH AVE 202
CHULA VISTA CA
91910-4410
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-3361
  • Fax: 619-427-6821
Mailing address:
  • Phone: 619-427-3361
  • Fax: 619-427-6821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY MARIE MORA
Title or Position: ADMINISTRATOR ASSISTANT
Credential:
Phone: 619-427-3361