Provider Demographics
NPI:1851324206
Name:ALHAMBRA FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:ALHAMBRA FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-2232
Mailing Address - Street 1:1336 W. VALLEY BLVD, #A
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3257
Mailing Address - Country:US
Mailing Address - Phone:626-281-2232
Mailing Address - Fax:626-281-7214
Practice Address - Street 1:1336 W. VALLEY BLVD, #A
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3257
Practice Address - Country:US
Practice Address - Phone:626-281-2232
Practice Address - Fax:626-281-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX67580Medicaid
CAGR0093620Medicaid
CA00A848670Medicaid
CA05D0565444OtherCLIA
CAGR0093620Medicaid
CA=========OtherEIN OF ALHAMBRA FAM MED
CA00A848670Medicaid
CAWA84867AMedicare ID - Type UnspecifiedRENDER # FOR J WONG
CA00AX67580Medicaid