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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