Provider Demographics
NPI:1598833469
Name:CITRUS VALLEY FAMILY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:CITRUS VALLEY FAMILY MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:I
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-931-2200
Mailing Address - Street 1:1400 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-1187
Mailing Address - Country:US
Mailing Address - Phone:626-931-2200
Mailing Address - Fax:626-931-2203
Practice Address - Street 1:1400 N HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1187
Practice Address - Country:US
Practice Address - Phone:626-931-2200
Practice Address - Fax:626-931-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48167261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48167Medicare UPIN