Provider Demographics
NPI:1043242142
Name:CALIFORNIA MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:CALIFORNIA MEDICAL CLINIC INC.
Other - Org Name:CLINICA MEDICA CALIFORNIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LELAND
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-467-1605
Mailing Address - Street 1:402 E HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-1618
Mailing Address - Country:US
Mailing Address - Phone:909-467-1605
Mailing Address - Fax:909-467-1608
Practice Address - Street 1:402 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-1618
Practice Address - Country:US
Practice Address - Phone:909-467-1605
Practice Address - Fax:909-467-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26321ZMedicare ID - Type UnspecifiedGROUP