Provider Demographics
NPI:1023130002
Name:SAN DIEGO WOMEN'S MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:SAN DIEGO WOMEN'S MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-268-7324
Mailing Address - Street 1:4282 GENESEE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4946
Mailing Address - Country:US
Mailing Address - Phone:858-268-7324
Mailing Address - Fax:858-268-3894
Practice Address - Street 1:4282 GENESEE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4946
Practice Address - Country:US
Practice Address - Phone:858-268-7324
Practice Address - Fax:858-268-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty