Healthcare Provider Details

I. General information

NPI: 1922541036
Provider Name (Legal Business Name): MINUTE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 LOMAS SANTA FE DR
SOLANA BEACH CA
92075-1412
US

IV. Provider business mailing address

7220 TEASDALE AVE
SAN DIEGO CA
92122-2829
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-6697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number95005171
License Number StateCA

VIII. Authorized Official

Name: TRACIE LYNN NUSCA
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 352-283-3717