Provider Demographics
NPI:1235278201
Name:ADULT MEDICINE CLINIC
Entity Type:Organization
Organization Name:ADULT MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODRIGO
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-470-9054
Mailing Address - Street 1:655 EUCLID AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-470-9054
Mailing Address - Fax:619-479-8380
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-470-9054
Practice Address - Fax:619-479-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty