CLARA LUCKY POLAK MD, INC. (NPI# 1356586465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356586465 |
| Entity Type | Organization |
| Organization Name | CLARA LUCKY POLAK MD, INC. |
| Practice Address |
480 4th Ave 202 Chula Vista CA 91910-4410 |
| Mailing Address |
9276 Scranton Rd Suite 100 San Diego CA 92121-7701 |
| Practice Telephone | 6194273361 |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2017-01-13 |
| Authorized Official Name | SCOTT PETERSON (CFO) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | A66649 | CA | Suppliers |
| Street Address |
480 4TH AVE 202 |
| City | CHULA VISTA |
| State | CA |
| Zip Code | 91910-4410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396749644 | Vera Rakic | Physical Therapist | 480 4th Ave, Suite 301, Chula Vista, CA 91910-4410 | 2005-06-01 |
| 1962912568 | Adam Michael Afflalo | Physician Assistant | 480 4th Ave, Chula Vista, CA 91910-4410 | 2017-10-09 |
| 1902359607 | Laura Bradley | Physician Assistant | 480 4th Ave, Suite 307, Chula Vista, CA 91910-4410 | 2016-07-28 |
| 1194171454 | Adult Medicine and Wellness Inc | Internal Medicine | 480 4th Ave, Suite 516, Chula Vista, CA 91910-4414 | 2016-05-05 |
| 1407211881 | Ernest Ritualo Mejia | Physician Assistant | 480 4th Ave, Suite 202, Chula Vista, CA 91910-4410 | 2015-12-29 |
| 1467832642 | Ellen Morrison | Physical Therapy Assistant | 480 4th Ave, Suite 509, Chula Vista, CA 91910-4410 | 2015-06-03 |
| 1215323753 | Happy Coronel Sanchez | Nurse Practitioner | 480 4th Ave, Chula Vista, CA 91910-4410 | 2015-04-11 |
| 1245658418 | Victor Mora D.d.s. | Dentist | 480 4th Ave, Ste # 314, Chula Vista, CA 91910-4410 | 2014-04-03 |
| 1679901516 | Raymundo Alatorre Jr. | Pharmacist | 480 4th Ave, Suite 100, Chula Vista, CA 91910-4410 | 2013-10-30 |
| 1700138732 | Jennifer Michelle Crittenden | Physical Therapist | 480 4th Ave, Suite 509, Chula Vista, CA 91910-4410 | 2012-10-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477194264 | Joshua Maurice Hayden | Dental Hygienist | 678 Thrid Ave, Chula Vista, CA 91910 | 2019-10-02 |
| 1255980504 | Samantha Bernaldo | Dental Hygienist | 668 Third Ave, Chula Vista, CA 91910 | 2019-09-10 |
| 1073179529 | Roshni Kakaiya | Student in an Organized Health Care Education/Training Program | 435 H Street, Cv112, Chula Vista, CA 91910 | 2019-05-09 |
| 1598232506 | Naria Le Mire | Dietitian, Registered | 288 Broadway #141a, Chula Vista, CA 91910 | 2018-10-28 |
| 1730676727 | Pei Chi Chain | Optometrist | 324 F Street., Chula Vista, CA 91910 | 2018-04-16 |
| 1104332741 | Teodoro David Pena | Dentist | 510 Broadway Ste 4-5, Chula Vista, CA 91910 | 2017-12-19 |
| 1538684865 | Camille Cooke | Counselor | 430 F. Street, Chula Vista, CA 91910 | 2017-08-08 |
| 1184146094 | Alexandra Lynn Scovill | Optometrist | Castillejos Eye Institute Medical Group, 342 F Street, Chula Vista, CA 91910 | 2017-07-12 |
| 1396270583 | Tam Trieu | Pharmacist | 555 Broaway Suite 1054, Chula Vista, CA 91910 | 2017-04-25 |
| 1548792815 | Sabrina Owens | Family Medicine | 499 H Street Cv112, Chula Vista, CA 91910 | 2017-03-28 |
| Find all providers in zip 91910 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| Find all providers with the same taxonomy | ||||
| City | CHULA VISTA |
| Zip Code | 91910 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.