Provider Demographics
NPI:1952886822
Name:OUR MISSION MEDICAL CLINIC
Entity Type:Organization
Organization Name:OUR MISSION MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BACANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-807-0401
Mailing Address - Street 1:1811 W KATELLA AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-6657
Mailing Address - Country:US
Mailing Address - Phone:657-220-4208
Mailing Address - Fax:714-333-4980
Practice Address - Street 1:1811 W KATELLA AVE STE 117
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-6657
Practice Address - Country:US
Practice Address - Phone:657-220-4208
Practice Address - Fax:714-333-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty