Provider Demographics
NPI:1225080864
Name:HISPANIC PHYSICIAN IPA MEDICO HISPANO
Entity Type:Organization
Organization Name:HISPANIC PHYSICIAN IPA MEDICO HISPANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ACCOUNTS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-637-2530
Mailing Address - Street 1:PO BOX 10718
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3718
Mailing Address - Country:US
Mailing Address - Phone:213-637-2530
Mailing Address - Fax:213-384-3373
Practice Address - Street 1:2208 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4002
Practice Address - Country:US
Practice Address - Phone:213-637-0925
Practice Address - Fax:213-736-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty