Provider Demographics
NPI:1205961034
Name:HEALTHCARE MEDICAL CLINIC OF POMONA INC.
Entity type:Organization
Organization Name:HEALTHCARE MEDICAL CLINIC OF POMONA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:EL ASMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-524-0555
Mailing Address - Street 1:822 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-4616
Mailing Address - Country:US
Mailing Address - Phone:909-524-0555
Mailing Address - Fax:909-524-0122
Practice Address - Street 1:822 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-4616
Practice Address - Country:US
Practice Address - Phone:909-524-0555
Practice Address - Fax:909-524-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619230Medicaid
CAZZZ65937ZOtherBLUE SHIELD BLUE CROSS
CAZZZ65937ZOtherBLUE SHIELD BLUE CROSS
CA00A619230Medicaid
CAW18977Medicare ID - Type UnspecifiedPOMONA LOCATION