Provider Demographics
NPI:1265606636
Name:CLINICA DEL SOL MEDICAL GROUP INC
Entity type:Organization
Organization Name:CLINICA DEL SOL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGO ARNULFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-772-3348
Mailing Address - Street 1:41120 WASHINGTON ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9215
Mailing Address - Country:US
Mailing Address - Phone:760-772-3348
Mailing Address - Fax:760-772-8414
Practice Address - Street 1:41120 WASHINGTON ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BERMUDA DUNES
Practice Address - State:CA
Practice Address - Zip Code:92203-9215
Practice Address - Country:US
Practice Address - Phone:760-772-3348
Practice Address - Fax:760-772-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60620207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G606200Medicare PIN
CAE90065Medicare UPIN