Provider Demographics
NPI:1760690200
Name:ADA DEL RIVERO-YAMUY MEDICAL CORP
Entity Type:Organization
Organization Name:ADA DEL RIVERO-YAMUY MEDICAL CORP
Other - Org Name:HUGHES AVENUE FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:DEL RIVERO YAMUY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-204-0104
Mailing Address - Street 1:3831 HUGHES AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-204-0104
Mailing Address - Fax:310-204-0171
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2751
Practice Address - Country:US
Practice Address - Phone:310-204-0104
Practice Address - Fax:310-204-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83694261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Medicaid