Provider Demographics
NPI:1053416420
Name:SAN CLEMENTE INTERNAL MEDICAL GROUP INC.
Entity type:Organization
Organization Name:SAN CLEMENTE INTERNAL MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCOIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA
Authorized Official - Phone:949-487-9034
Mailing Address - Street 1:665 CAMINO DE LOS MARES STE 309
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2841
Mailing Address - Country:US
Mailing Address - Phone:949-487-9034
Mailing Address - Fax:949-493-3721
Practice Address - Street 1:665 CAMINO DE LOS MARES STE 309
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2841
Practice Address - Country:US
Practice Address - Phone:949-487-9034
Practice Address - Fax:949-493-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13859Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER