Healthcare Provider Details

I. General information

NPI: 1508068016
Provider Name (Legal Business Name): SENTA CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 CAMINO DEL RIO NORTH SUITE 200
SAN DIEGO CA
92108-1716
US

IV. Provider business mailing address

3590 CAMINO DEL RIO NORTH SUITE 200
SAN DIEGO CA
92108-1716
US

V. Phone/Fax

Practice location:
  • Phone: 619-810-1010
  • Fax: 619-810-1011
Mailing address:
  • Phone: 619-810-1010
  • Fax: 619-810-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BRIAN H WEEKS
Title or Position: PHYSICIAN
Credential: MD
Phone: 619-810-1010