Provider Demographics
NPI:1811417652
Name:CLINICA DEL PUEBLO LAMONT
Entity Type:Organization
Organization Name:CLINICA DEL PUEBLO LAMONT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-845-1788
Mailing Address - Street 1:10200 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAMONT
Mailing Address - State:CA
Mailing Address - Zip Code:93241-1700
Mailing Address - Country:US
Mailing Address - Phone:661-845-1788
Mailing Address - Fax:661-845-1791
Practice Address - Street 1:10200 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LAMONT
Practice Address - State:CA
Practice Address - Zip Code:93241-1700
Practice Address - Country:US
Practice Address - Phone:661-845-1788
Practice Address - Fax:661-845-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12281207Q00000X
CAA85474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI30581OtherUPIN