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General NPI Number Information
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NPI Number | 1891019022
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Entity Type | Organization
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Legal Business Name | CLINICA SAN DIEGO INC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 4245 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85015-5109
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Country | US
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Telephone | 602-277-8885
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Fax |
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Provider Business Mailing Address
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Address Line | 8026 W LUKE AVE
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City | GLENDALE
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State | AZ
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Zip | 85303-5166
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Country | US
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Telephone | 623-444-6207
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROSARIO YOLANDA ESQUEDA DE SAINOS
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Credential | NONE
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Telephone | 602-277-8885
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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 | 33819
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License Number State | AZ
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