Provider Demographics
NPI:1457567026
Name:HERRERA & OBESO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HERRERA & OBESO MEDICAL GROUP INC
Other - Org Name:HERRERA & OBESO MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-337-1800
Mailing Address - Street 1:1135 S SUNSET AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3938
Mailing Address - Country:US
Mailing Address - Phone:626-337-1800
Mailing Address - Fax:626-337-1449
Practice Address - Street 1:1135 S SUNSET AVE STE 211
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3938
Practice Address - Country:US
Practice Address - Phone:626-337-1800
Practice Address - Fax:626-337-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
CAAO54745302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15228Medicare ID - Type Unspecified
CAG55180Medicare UPIN
CAH11231Medicare UPIN