Provider Demographics
NPI:1073830485
Name:SAN ANTONIO FAMILY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:SAN ANTONIO FAMILY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOCSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:619-754-5809
Mailing Address - Street 1:36 N EUCLID AVE STE C
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1955
Mailing Address - Country:US
Mailing Address - Phone:619-255-2950
Mailing Address - Fax:619-756-6981
Practice Address - Street 1:36 N EUCLID AVE STE C
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-1955
Practice Address - Country:US
Practice Address - Phone:619-255-2950
Practice Address - Fax:619-756-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54939261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care