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General NPI Number Information
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NPI Number | 1598686966
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Entity Type | Organization
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Legal Business Name | EASTLAKE URGENT CARE A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 2436 FENTON ST BLDG 6
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City | CHULA VISTA
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State | CA
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Zip | 91914-3516
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Country | US
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Telephone | 619-789-7385
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 FENTON ST BLDG 6
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City | CHULA VISTA
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State | CA
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Zip | 91914-3516
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Country | US
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Telephone | 619-789-7385
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TAREK HASSANEIN
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Credential | MD
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Telephone | 619-990-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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