| NPI | 1942659149 |
|---|---|
| Doing Business As | SOUTH BAY PRIMARY MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TRACY LEE POLANCO Owner/President 619-591-9001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A80610) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA A76528) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2016-11-16 |