| Clinica Medica De La Mora Inc | |
|
995 Gateway Center Way Suite 202 San Diego CA 92102-4500 | |
| (619) 264-3107 | |
| (619) 264-6927 |
| Full Name | Clinica Medica De La Mora Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 995 Gateway Center Way, San Diego, California |
| Authorized Official Name and Position | Oscar Manuel De La Mora (OWNER) |
| Authorized Official Contact | 6192643107 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica De La Mora Inc 995 Gateway Center Way Suite 202 San Diego CA 92102-4500 Ph: (619) 264-3107 | Clinica Medica De La Mora Inc 995 Gateway Center Way Suite 202 San Diego CA 92102-4500 Ph: (619) 264-3107 |
| NPI Number | 1649598772 |
|---|---|
| Provider Enumeration Date | 05/13/2010 |
| Last Update Date | 05/13/2010 |
| Medicare PECOS PAC ID | 9335279207 |
|---|---|
| Medicare Enrollment ID | O20120319000405 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649598772 | NPI | - | NPPES |
| A050769 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | C50916 (California) | Primary |
| 207R00000X | Internal Medicine | A30061 (California) | Secondary |
| 208000000X | Pediatrics | A50769 (California) | Secondary |
| Provider Name | Eugenio R Grunvald |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1942356662 PECOS PAC ID: 4981594140 Enrollment ID: I20051007000897 |
| Provider Name | Ramachander Nanduri |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093721896 PECOS PAC ID: 1254348030 Enrollment ID: I20060320000637 |
| Provider Name | Oscar Manuel De La Mora |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1982703898 PECOS PAC ID: 4688704562 Enrollment ID: I20120319000429 |
| Provider Name | Eric Jay Storey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205598984 PECOS PAC ID: 5890164396 Enrollment ID: I20221205002556 |
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