Organization
CCTC, CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ENRIQUE CHUNG (PRESIDENT)
(619) 253-6451
Entity
Organization
Contact information
Practice address
6244 EL CAJON BLVD, SAN DIEGO, CA 92115-3918
(888) 628-6680
Mailing address
1215 HOPLAND CT, CHULA VISTA, CA 91913-1438
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/23/2019
Last updated
01/23/2019
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