Provider Demographics
NPI:1477167062
Name:CLINICA DEL PUEBLO CARCAMO A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLINICA DEL PUEBLO CARCAMO A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
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:909-815-1991
Mailing Address - Street 1:14083 HASTINGS RANCH LN
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2112
Mailing Address - Country:US
Mailing Address - Phone:951-285-4393
Mailing Address - Fax:760-948-6244
Practice Address - Street 1:14650 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5333
Practice Address - Country:US
Practice Address - Phone:626-337-1360
Practice Address - Fax:626-962-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty