| Organization Name: | IMPERIAL BEACH COMMUNITY CLINIC |
| NPI Number: | 1790718351 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CONSTANCE KIRK (EXECUTIVE DIRECTOR) |
| Mailing Address: | 949 Palm Avenue Imperial Beach |
| State: | CA US |
| Postal Code: | 919321503 |
| Phone Number: | 6194293733 |
| Fax Number: | 6194296457 |
| NPI Enumeration Date: | 07/08/2006 |
| NPI Last Update Date: | 05/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |