Provider Demographics
NPI:1508284878
Name:SANTA ADELINA MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:SANTA ADELINA MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:626-812-9733
Mailing Address - Street 1:680 E ALOSTA AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-2705
Mailing Address - Country:US
Mailing Address - Phone:626-812-9733
Mailing Address - Fax:626-981-2974
Practice Address - Street 1:680 E ALOSTA AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2705
Practice Address - Country:US
Practice Address - Phone:626-812-9733
Practice Address - Fax:626-981-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty