Provider Demographics
NPI:1942578943
Name:CAL CITY CLINIC
Entity Type:Organization
Organization Name:CAL CITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHMEAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-547-3906
Mailing Address - Street 1:41019 WOODSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5746
Mailing Address - Country:US
Mailing Address - Phone:661-547-3906
Mailing Address - Fax:661-622-4257
Practice Address - Street 1:9300 N LOOP BLVD STE A&B
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-2269
Practice Address - Country:US
Practice Address - Phone:760-373-1256
Practice Address - Fax:760-373-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78625261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM18534GMedicaid
CA1093898454Medicaid
CARHM18534GMedicaid
CA553894Medicare Oscar/Certification