Provider Demographics
NPI:1477194082
Name:HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:213-739-3282
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-1682
Mailing Address - Country:US
Mailing Address - Phone:213-739-3282
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:213-739-3282
Practice Address - Fax:626-443-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty