Provider Demographics
NPI:1972881241
Name:SAN CLEMENTE MEDI-CENTER
Entity type:Organization
Organization Name:SAN CLEMENTE MEDI-CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DARSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAKIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-492-4994
Mailing Address - Street 1:910 S EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4279
Mailing Address - Country:US
Mailing Address - Phone:760-473-0444
Mailing Address - Fax:
Practice Address - Street 1:4508 AVENIDA PRIVADO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-7735
Practice Address - Country:US
Practice Address - Phone:760-473-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21502302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization