Provider Demographics
NPI:1891019022
Name:CLINICA SAN DIEGO INC
Entity Type:Organization
Organization Name:CLINICA SAN DIEGO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:YOLANDA
Authorized Official - Last Name:ESQUEDA DE SAINOS
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:602-277-8885
Mailing Address - Street 1:8026 W LUKE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85303-5166
Mailing Address - Country:US
Mailing Address - Phone:623-444-6207
Mailing Address - Fax:
Practice Address - Street 1:4245 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5109
Practice Address - Country:US
Practice Address - Phone:602-277-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33819261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care