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Organization
FAMILY & PREVENTIVE MEDICAL CENTER OF CHULA VISTA A MEDICAL CORPORATIO
Active
Organization
FAMILY & PREVENTIVE MEDICAL CENTER OF CHULA VISTA A MEDICAL CORPORATIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN A MALONE (PRESIDENT)
(619) 421-4257
Entity
Organization
Contact information
Practice address
1415 RIDGEBACK RD, #4, CHULA VISTA, CA 91910-6932
(619) 421-4257
(619) 421-6913
Mailing address
1415 RIDGEBACK RD, #4, CHULA VISTA, CA 91910-6932
(619) 421-4257
(619) 421-6913
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G46053
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W14157
MEDICARE ID-TYPE UNSPECI
CA
Enumeration date
12/20/2006
Last updated
11/11/2024
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