Provider Demographics
NPI:1225681422
Name:VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC
Other - Org Name:VALLEY CLINICA MEDICA GENERAL, MEDICAL CENTER INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA BACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-637-2530
Mailing Address - Street 1:6511 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1425
Mailing Address - Country:US
Mailing Address - Phone:818-901-9090
Mailing Address - Fax:
Practice Address - Street 1:11026 VALLEY MALL
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2617
Practice Address - Country:US
Practice Address - Phone:626-443-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty