Provider Demographics
NPI:1326680273
Name:YOUNITY MEDICAL AFFILIATES IPA, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:YOUNITY MEDICAL AFFILIATES IPA, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-488-6762
Mailing Address - Street 1:1615 SWEETWATER RD STE F
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7655
Mailing Address - Country:US
Mailing Address - Phone:619-488-6762
Mailing Address - Fax:619-488-6762
Practice Address - Street 1:1615 SWEETWATER RD STE F
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7655
Practice Address - Country:US
Practice Address - Phone:619-488-6762
Practice Address - Fax:619-488-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization