Provider Demographics
NPI:1144571985
Name:CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:CLINICA MEDICA MI PUEBLO, MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-726-0333
Mailing Address - Street 1:6055 E WASHINGTON BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2449
Mailing Address - Country:US
Mailing Address - Phone:323-726-0333
Mailing Address - Fax:323-726-0313
Practice Address - Street 1:602 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3209
Practice Address - Country:US
Practice Address - Phone:951-256-2783
Practice Address - Fax:951-808-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care