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General NPI Number Information
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NPI Number | 1073830485
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO FAMILY MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 04/24/2010
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Last Update Date | 04/24/2010
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Provider Practice Location Address
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Address Line | 36 N EUCLID AVE STE C
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City | NATIONAL CITY
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State | CA
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Zip | 91950-1955
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Country | US
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Telephone | 619-255-2950
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Fax | 619-756-6981
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Provider Business Mailing Address
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Address Line | 36 N EUCLID AVE STE C
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City | NATIONAL CITY
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State | CA
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Zip | 91950-1955
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Country | US
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Telephone | 619-255-2950
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Fax | 619-756-6981
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDWARD S JOCSON
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Credential | PA-C
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Telephone | 619-754-5809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G54939
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License Number State | CA
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