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General NPI Number Information
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NPI Number | 1467258772
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Entity Type | Organization
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Legal Business Name | CLARA LUCKY POLAK MD, INC.
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 22 W 35TH ST STE 101
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7926
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Country | US
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Telephone | 619-427-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 22 W 35TH ST STE 101
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City | NATIONAL CITY
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State | CA
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Zip | 91950-7926
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Country | US
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Telephone | 619-427-3361
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR ASSISTANT
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Name | KATHYN MARIE MORA
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Credential |
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Telephone | 619-827-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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