Provider Demographics
NPI:1841232394
Name:PICO RIVERA COMMUNITY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:PICO RIVERA COMMUNITY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-692-0621
Mailing Address - Street 1:4705 DURFEE AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2037
Mailing Address - Country:US
Mailing Address - Phone:562-692-0621
Mailing Address - Fax:562-695-0660
Practice Address - Street 1:4705 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2037
Practice Address - Country:US
Practice Address - Phone:562-692-0621
Practice Address - Fax:562-695-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX034AMedicare PIN
CAW10194Medicare PIN