Provider Demographics
NPI:1467258772
Name:CLARA LUCKY POLAK MD, INC.
Entity type:Organization
Organization Name:CLARA LUCKY POLAK MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHYN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-827-0572
Mailing Address - Street 1:22 W 35TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7926
Mailing Address - Country:US
Mailing Address - Phone:619-427-3361
Mailing Address - Fax:
Practice Address - Street 1:22 W 35TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7926
Practice Address - Country:US
Practice Address - Phone:619-427-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty