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NPI Code Detail

MEDICARE: CLARA LUCKY POLAK MD, INC.

MEDICARE: CLARA LUCKY POLAK MD, INC.
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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number : 1356586465
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARA LUCKY POLAK MD, INC.
Provider Business Mailing Address
First Line : 9276 SCRANTON RD
Second Line : SUITE 100
City : SAN DIEGO
State : CA
Zip : 92121-7701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 22 W 35TH ST STE 101
Second Line :
City : NATIONAL CITY
State : CA
Zip : 91950-7926
Country : US
Telephone Number : 619-427-3361
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : CLARA LUCY POLAK
Credential : MD
Telephone Number : 619-427-3362
Provider Enumeration Date : 12/04/2008
Last Update Date : 11/15/2024

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