Organization
CIECAL RC INC
Active
Other names
South Bay Primary Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TRACY LEE POLANCO M.D. (OWNER/PRESIDENT)
(619) 591-9001
Entity
Organization
Contact information
Practice address
769 MEDICAL CENTER CT, SUITE 303, CHULA VISTA, CA 91911-6602
(619) 591-9001
(619) 591-9211
Mailing address
769 MEDICAL CENTER CT, SUITE 303, CHULA VISTA, CA 91911-6602
(619) 591-9001
(619) 591-9211
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
A76528
CA
261QP2300X
Primary Care Clinic/Center
Primary
A80610
CA
Other
Enumeration date
06/08/2016
Last updated
11/16/2016
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