Provider Demographics
NPI:1093028896
Name:SANTA MARIA CLINICA FAMILIAR INC
Entity Type:Organization
Organization Name:SANTA MARIA CLINICA FAMILIAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:562-266-3032
Mailing Address - Street 1:308 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4847
Mailing Address - Country:US
Mailing Address - Phone:562-266-3032
Mailing Address - Fax:562-266-3036
Practice Address - Street 1:308 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-4847
Practice Address - Country:US
Practice Address - Phone:562-266-3032
Practice Address - Fax:562-266-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105315208600000X
CAPA12479363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty