Provider Demographics
NPI:1932249315
Name:COMPREHENSIVE MED CTR INC
Entity Type:Organization
Organization Name:COMPREHENSIVE MED CTR INC
Other - Org Name:CLINICA MEDICA COMUNIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-882-4015
Mailing Address - Street 1:2286 S GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-5645
Mailing Address - Country:US
Mailing Address - Phone:909-464-2818
Mailing Address - Fax:
Practice Address - Street 1:2286 S GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-5645
Practice Address - Country:US
Practice Address - Phone:909-464-2818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094881Medicaid
CAZZZ08860ZOtherBLUE CROSS GROUP #
CA00A521760Medicaid
CA00G841270Medicaid
CA00A521760Medicaid
CAWG84127DMedicare ID - Type UnspecifiedANTHONY KINGSLEY M.D.
CAG25651Medicare UPIN
CAG62500Medicare UPIN
CAGR0094881Medicaid