Organization
IMPERIAL BEACH COMMUNITY CLINIC
Active
Organization
IMPERIAL BEACH COMMUNITY CLINIC
Active
Other names
Imperial Beach Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE KIRK (EXECUTIVE DIRECTOR)
(619) 429-5387
Entity
Organization
Contact information
Practice address
949 PALM AVENUE, IMPERIAL BEACH, CA 91932-1503
(619) 429-3733
(619) 429-6457
Mailing address
PO BOX 459, IMPERIAL BEACH, CA 91933-0459
(619) 429-3733
(619) 429-6457
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0683042
LABORATORY CLIA NUMBER
—
01
—
40
COUNTY MEDICAL SERVICES
CA
01
—
BCP11826F
CDP
CA
01
—
EAP11826F
EAPC
CA
01
—
FHC11826F
MEDI CAL
CA
05
—
FHC11826F
—
CA
01
—
HAP11826F
FAMILY PACT
CA
Enumeration date
07/08/2006
Last updated
05/27/2010
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