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NPI Code Detail

MEDICARE: MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF SAN DIEGO INC

MEDICARE: MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF SAN DIEGO 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
1101YP2500XProfessional Counselor
21041C0700XClinical Social Worker
3106H00000XMarriage & Family Therapist
4207Q00000XFamily Medicine Physician
5363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1568659233
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF SAN DIEGO INC
Provider Business Mailing Address
First Line : PO BOX 772
Second Line : CREDENTIALING-MC 2295
City : WOONSOCKET
State : RI
Zip : 02895-0784
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Provider Business Practice Location Address
First Line : 2760 FLETCHER PKWY
Second Line :
City : EL CAJON
State : CA
Zip : 92020-2110
Country : US
Telephone Number : 866-389-2727
Fax Number : 401-406-3539
Authorized Official
Title or Position : ADMINISTRATOR
Name : DEBORAH PINCINCE
Credential :
Telephone Number : 401-770-3813
Provider Enumeration Date : 09/26/2007
Last Update Date : 10/11/2024

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