Provider Demographics
NPI:1477999290
Name:PEOPLES COMMUNITY CLINIC
Entity Type:Organization
Organization Name:PEOPLES COMMUNITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:HOURY
Authorized Official - Middle Name:
Authorized Official - Last Name:KARABIBERJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-928-5052
Mailing Address - Street 1:540 N SAN JACINTO ST
Mailing Address - Street 2:SUITE Q
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3154
Mailing Address - Country:US
Mailing Address - Phone:951-929-4000
Mailing Address - Fax:951-929-4100
Practice Address - Street 1:540 N SAN JACINTO ST
Practice Address - Street 2:SUITE Q
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3154
Practice Address - Country:US
Practice Address - Phone:951-929-4000
Practice Address - Fax:951-929-4100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEOPLES COMMUNITY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77862207Q00000X
CAA133706261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid
CA1477999290Medicare UPIN
CA1477999290Medicare PIN
CA1477999290Medicare NSC