1043864861 NPI number — HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC

Table of content: (NPI 1043864861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043864861 NPI number — HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, 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:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1043864861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6347 PACIFIC BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTINGTON PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90255-4101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-583-8383
Provider Business Mailing Address Fax Number:
323-583-8399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11026 VALLEY MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-443-4300
Provider Business Practice Location Address Fax Number:
626-443-9646
Provider Enumeration Date:
07/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA BACHMANN
Authorized Official First Name:
JUAN CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
213-637-2530

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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