Provider Demographics
NPI:1275656761
Name:CLINICA MEDICA FAMILIAR-PHN, INC
Entity Type:Organization
Organization Name:CLINICA MEDICA FAMILIAR-PHN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-421-2121
Mailing Address - Street 1:280 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5924
Mailing Address - Country:US
Mailing Address - Phone:909-421-2121
Mailing Address - Fax:909-421-0491
Practice Address - Street 1:280 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5924
Practice Address - Country:US
Practice Address - Phone:909-421-2121
Practice Address - Fax:909-421-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082770OtherMEDI-CAL PROVIDER NUMBER