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General NPI Number Information
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NPI Number | 1942003991
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Entity Type | Organization
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Legal Business Name | TA COMMUNITY MEDICAL CLINIC
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Dates
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Enumeration Date | 03/27/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 502 EUCLID AVE STE 302
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2995
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Country | US
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Telephone | 619-330-7402
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Fax | 619-330-5494
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Provider Business Mailing Address
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Address Line | 4263 TIERRA REJADA RD # 188
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City | MOORPARK
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State | CA
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Zip | 93021-3772
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Country | US
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Telephone | 619-330-7402
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Fax | 619-330-5494
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHAIK SAHEB
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Credential | MD
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Telephone | 619-330-7402
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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 |
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License Number State |
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