1104924984 NPI number — HEALTHY CHOICES MEDICAL CLINIC, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104924984 NPI number — HEALTHY CHOICES MEDICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHY CHOICES MEDICAL CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HEALTHY CHOICES FAMILY MEDICAL GROUP, A.M.C.
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104924984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 SOUTH ATLANTIC BLVD.
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MONTEREY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91754-4730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-281-0125
Provider Business Mailing Address Fax Number:
626-281-1526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 SOUTH ATLANTIC BLVD.
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-281-0125
Provider Business Practice Location Address Fax Number:
626-281-1526
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MENDOZA
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
626-281-0125

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A73075 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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