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NPI Code Detail

MEDICARE: CLARA LUCY POLAK, M.D. INC.

MEDICARE: CLARA LUCY POLAK, M.D. 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1841342243
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLARA LUCY POLAK, M.D. INC.
Provider Business Mailing Address
First Line : 480 4TH AVE
Second Line : 202
City : CHULA VISTA
State : CA
Zip : 91910-4410
Country : US
Telephone Number : 619-427-3361
Fax Number : 619-427-6821
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 : 619-427-6821
Authorized Official
Title or Position : ADMINISTRATOR ASSISTANT
Name : MS. KATHY MARIE MORA
Credential :
Telephone Number : 619-427-3361
Provider Enumeration Date : 01/17/2007
Last Update Date : 05/17/2024

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