Provider Demographics
NPI:1164728788
Name:HESPERIA CLINICA MEDICA FAMILIAR A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HESPERIA CLINICA MEDICA FAMILIAR A MEDICAL CORPORATION
Other - Org Name:HESPERIA CLINICA MEDICA FAMILIAR A MEDICAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ-VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-948-2242
Mailing Address - Street 1:15888 MAIN ST
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3467
Mailing Address - Country:US
Mailing Address - Phone:760-948-2242
Mailing Address - Fax:760-948-6244
Practice Address - Street 1:15888 MAIN ST
Practice Address - Street 2:SUITE 112B
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3467
Practice Address - Country:US
Practice Address - Phone:760-948-2242
Practice Address - Fax:760-948-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty