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General NPI Number Information
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NPI Number | 1538223813
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Entity Type | Organization
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Legal Business Name | FAMILY & PREVENTIVE MEDICAL CENTER OF CHULA VISTA A MEDICAL CORPORATIO
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1415 RIDGEBACK RD #4
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City | CHULA VISTA
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State | CA
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Zip | 91910-6932
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Country | US
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Telephone | 619-421-4257
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Fax | 619-421-6913
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Provider Business Mailing Address
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Address Line | 1415 RIDGEBACK RD #4
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City | CHULA VISTA
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State | CA
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Zip | 91910-6932
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Country | US
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Telephone | 619-421-4257
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Fax | 619-421-6913
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN A MALONE
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Credential |
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Telephone | 619-421-4257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G46053
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License Number State | CA
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