Healthcare Provider Details

I. General information

NPI: 1215959549
Provider Name (Legal Business Name): IRENE M ZINK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3177 OCEAN VIEW BLVD
SAN DIEGO CA
92113
US

IV. Provider business mailing address

1275 30TH ST
SAN DIEGO CA
92154-3476
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax: 619-231-3955
Mailing address:
  • Phone: 619-662-4100
  • Fax: 619-231-3955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: