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General NPI Number Information
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NPI Number | 1750644258
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Entity Type | Organization
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Legal Business Name | JURKOWSKI MEDICAL CORPORATION
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 10605 SCRIPPS POWAY PKWY SUITE C
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City | SAN DIEGO
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State | CA
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Zip | 92131-3925
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Country | US
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Telephone | 858-622-0554
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Fax | 858-622-1417
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Provider Business Mailing Address
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Address Line | 10605 SCRIPPS POWAY PKWY SUITE C
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City | SAN DIEGO
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State | CA
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Zip | 92131-3925
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Country | US
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Telephone | 858-622-0554
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Fax | 858-622-1417
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | LEONARD A. JURKOWSKI
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Credential | M.D
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Telephone | 858-622-0554
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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 | C43217
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C43217
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 1750644258
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License Number State | CA
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