Provider Demographics
NPI:1689728735
Name:ACCESS IPA
Entity Type:Organization
Organization Name:ACCESS IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZUCENA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-457-5579
Mailing Address - Street 1:880 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4700
Mailing Address - Country:US
Mailing Address - Phone:626-457-5579
Mailing Address - Fax:626-457-7274
Practice Address - Street 1:880 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4700
Practice Address - Country:US
Practice Address - Phone:626-457-5579
Practice Address - Fax:626-457-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization