Provider Demographics
NPI:1508046251
Name:CLINICA PRENATAL SAN JOSE, INC.
Entity Type:Organization
Organization Name:CLINICA PRENATAL SAN JOSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-966-9795
Mailing Address - Street 1:1220 HEMLOCK WAY
Mailing Address - Street 2:STE. 201
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3650
Mailing Address - Country:US
Mailing Address - Phone:714-966-9795
Mailing Address - Fax:714-966-7869
Practice Address - Street 1:1220 HEMLOCK WAY STE 200
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3655
Practice Address - Country:US
Practice Address - Phone:714-966-9795
Practice Address - Fax:714-966-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG678871207VX0000X
CAA913090207VX0000X
CA207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A913090Medicaid
CA00G678871Medicaid