Provider Demographics
NPI:1356586465
Name:CLARA LUCKY POLAK MD, INC.
Entity type:Organization
Organization Name:CLARA LUCKY POLAK MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:LUCY
Authorized Official - Last Name:POLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-427-3362
Mailing Address - Street 1:9276 SCRANTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-7701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 W 35TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7926
Practice Address - Country:US
Practice Address - Phone:619-427-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLARA LUCKY POLAK MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-04
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty