institution
Mountain Lake Medical Grp Pc
Primary Care Clinic/Center in Pollock Pines, California
NPI 1588973788

Mountain Lake Medical Grp Pc is a Primary Care Clinic/Center based in Pollock Pines, CA and is specialized in Primary Care. Mountain Lake Medical Grp Pc practices in Pollock Pines, CA. The NPI Number for Mountain Lake Medical Grp Pc is 1588973788 and holds a License No. G32582 (California).

The current practice location address for Mountain Lake Medical Grp Pc is 6156 Pony Express Trl, Pollock Pines, CA and can be reached out via phone at 530-644-6044 and via fax at 530-644-0125.

Location: 6156 Pony Express Trl, Pollock Pines, CA, 95726-9649
institution
Provider Profile Details
NPI Number
1588973788
Provider Name
Mountain Lake Medical Grp Pc
Credential
Provider Entity Type
Organization
Address
6156 Pony Express Trl, Pollock Pines, CA, 95726-9649
Phone Number
530-644-6044
Fax Number
530-644-0125
Provider Enumeration Date
10/05/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4774218 05 CA
institution
Provider Business Practice Location Address Details
Address
6156 Pony Express Trl
City
State
Zip
95726-9649
Phone Number
530-644-6044
Fax Number
530-644-0125
person
Provider Business Mailing Address Details
Address
6156 Pony Express Trl
City
State
Zip
95726-9649
Phone Number
530-644-6044
Fax Number
530-644-0125
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
License No.
G32582 (California)
Definition
Definition to come...
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