IMPERIAL BEACH COMMUNITY CLINIC (NPI# 1790718351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790718351 |
| Entity Type | Organization |
| Organization Name | IMPERIAL BEACH COMMUNITY CLINIC |
| Other Organization Name | IMPERIAL BEACH HEALTH CENTER |
| Practice Address |
949 Palm Avenue Imperial Beach CA 91932-1503 |
| Mailing Address |
Po Box 459 Imperial Beach CA 91933-0459 |
| Practice Telephone | 6194293733 |
| Practice Fax Number | 6194296457 |
| Mailing Telephone | 6194293733 |
| Mailing Fax Number | 6194296457 |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2010-05-27 |
| Authorized Official Name | CONSTANCE KIRK (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 6194295387 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LABORATORY CLIA NUMBER | 05D0683042 | 01 | |
| CA | EAPC | EAP11826F | 01 |
| CA | COUNTY MEDICAL SERVICES | 40 | 01 |
| CA | FHC11826F | 05 | |
| CA | FAMILY PACT | HAP11826F | 01 |
| CA | CDP | BCP11826F | 01 |
| CA | MEDI CAL | FHC11826F | 01 |
| Other Name | Type Code |
|---|---|
| Imperial Beach Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215246996 | Imperial Beach Community Clinic | Clinic/Center | 1016 Outer Rd, San Diego, CA 92154-1351 | 2010-09-29 |
| 1508028200 | Imperial Beach Community Clinic | Family Medicine | 949 Palm Avenue, Imperial Beach, CA 91932-1503 | 2008-06-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | IMPERIAL BEACH COMMUNITY CLINIC | 949 Palm Ave, Imperial Beach, CA 91932 |
| Street Address |
949 PALM AVENUE |
| City | IMPERIAL BEACH |
| State | CA |
| Zip Code | 91932-1503 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508028200 | Imperial Beach Community Clinic | Family Medicine | 949 Palm Avenue, Imperial Beach, CA 91932-1503 | 2008-06-25 |
| 1992837629 | Leonor A Ordonez | Family Medicine | 949 Palm Avenue, Imperial Beach Health Center, Imperial Beach, CA 91932-1503 | 2007-03-09 |
| 1720171507 | Eric John Leute | Family Medicine | 949 Palm Avenue, Imperial Beach Health Center, Imperial Beach, CA 91932 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962994525 | Seacoast Behavior, LLC | Behavioral Analyst | 536 Shorebird Way, Imperial Beach, CA 91932 | 2018-05-30 |
| 1508363391 | M Mallempalli Professional Dental Corporation | Dentist | 600 Palm Ave., Suite#116, Imperial Beach, CA 91932 | 2018-04-09 |
| 1013440502 | Marice Angelic Dominguez | Respiratory Therapist, Registered | 1021 Elder Ave, Imperial Beach, CA 91932 | 2017-04-11 |
| 1003277856 | Samuel Wood | Registered Nurse | 803 Grove Ave, Imperial Beach, CA 91932 | 2016-03-08 |
| 1992033427 | Kathleen Helen Austin | Registered Nurse | 785 8th St, Imperial Beach, CA 91932 | 2009-11-20 |
| 1538365549 | Dorothy Mae Rumsey | Marriage & Family Therapist | 1237 East Lane, Imperial Beach, CA 91932 | 2007-06-26 |
| 1427062918 | Vernon Greg Phillips | Family Medicine | 707 Palm Ave, Imperial Beach, CA 91932 | 2006-07-28 |
| 1164489662 | Ralph Edwin Tuttle | Family Medicine | Comncwgruone, Nolf Ib Bldg 184, San Diego, CA 91932 | 2006-04-27 |
| 1154306231 | Solara Medical Supplies, LLC | Durable Medical Equipment & Medical Supplies | 720 Hwy 75, Imperial Beach, CA 91932 | 2005-12-12 |
| 1720283211 | Fabiola Del Aguila | Psychologist | 949 Palm Ave, Imperial Beach, CA 91932 | 2007-06-15 |
| Find all providers in zip 91932 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
| City | IMPERIAL BEACH |
| Zip Code | 91932 |
Please comment or provide details below to improve the information on IMPERIAL BEACH COMMUNITY CLINIC.
| 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.