MEDICARE: PLANNED PARENTHOOD PACIFIC SOUTHWEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	05D1062703	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316148125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLANNED PARENTHOOD PACIFIC SOUTHWEST

Provider Business Mailing Address
First Line	:	1075 CAMINO DEL RIO S
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3538
Country	:	US
Telephone Number	:	619-881-4516
Fax Number	:	619-291-6855

Provider Business Practice Location Address
First Line	:	2017 1ST AVE STE 300
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2033
Country	:	US
Telephone Number	:	619-881-4516
Fax Number	:	619-291-6855

Authorized Official
Title or Position	:	DIRECTOR
Name	:	THERESA GONZALES
Credential	:
Telephone Number	:	619-881-4516

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	01/24/2013

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Directions to “PLANNED PARENTHOOD PACIFIC SOUTHWEST ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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