Provider Demographics
NPI:1770984254
Name:CLINICA MEDICA MI FAMILIA DE PALMDALE, INC.
Entity type:Organization
Organization Name:CLINICA MEDICA MI FAMILIA DE PALMDALE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-266-0800
Mailing Address - Street 1:1037 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4745
Mailing Address - Country:US
Mailing Address - Phone:661-266-0800
Mailing Address - Fax:
Practice Address - Street 1:1037 E PALMDALE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4745
Practice Address - Country:US
Practice Address - Phone:661-266-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15859363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty