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General NPI Number Information
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NPI Number | 1053416420
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Entity Type | Organization
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Legal Business Name | SAN CLEMENTE INTERNAL MEDICAL GROUP INC.
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 665 CAMINO DE LOS MARES STE 309
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2841
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Country | US
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Telephone | 949-487-9034
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Fax | 949-493-3721
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Provider Business Mailing Address
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Address Line | 665 CAMINO DE LOS MARES STE 309
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2841
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Country | US
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Telephone | 949-487-9034
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Fax | 949-493-3721
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DEBBIE FRANCOIS
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Credential | CCMA
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Telephone | 949-487-9034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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