Provider Demographics
NPI:1952464208
Name:SANTA FE MEDICAL CLINIC, INC
Entity Type:Organization
Organization Name:SANTA FE MEDICAL CLINIC, INC
Other - Org Name:MAGANA SANTA FE MEDICAL CLINIC, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-942-1200
Mailing Address - Street 1:8338 ROSEMEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5111
Mailing Address - Country:US
Mailing Address - Phone:562-942-1200
Mailing Address - Fax:562-942-8004
Practice Address - Street 1:8338 ROSEMEAD BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-5111
Practice Address - Country:US
Practice Address - Phone:562-942-1200
Practice Address - Fax:562-942-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952464208Medicaid
CA1952464208Medicaid