Provider Demographics
NPI:1306044680
Name:NUMBER ONE CALIFORNIA HISPANO MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:NUMBER ONE CALIFORNIA HISPANO MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PASUHUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-784-4772
Mailing Address - Street 1:4010 MISSION INN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3205
Mailing Address - Country:US
Mailing Address - Phone:951-784-4772
Mailing Address - Fax:
Practice Address - Street 1:4010 MISSION INN AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3205
Practice Address - Country:US
Practice Address - Phone:951-784-4772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A396660Medicaid
CAA29198Medicare UPIN
CA00A396660Medicare ID - Type Unspecified
CAA40750Medicare ID - Type Unspecified
CA00A396660Medicaid