| Active Healthcare Medical Group Inc | |
|
512 S Glendora Ave West Covina CA 91790-3022 | |
| (626) 337-2888 | |
| Not Available |
| Full Name | Active Healthcare Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 512 S Glendora Ave, West Covina, California |
| Authorized Official Name and Position | Miguel Domingo (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6263372888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Healthcare Medical Group Inc 512 S Glendora Ave West Covina CA 91790-3022 Ph: (626) 337-2888 | Active Healthcare Medical Group Inc 512 S Glendora Ave West Covina CA 91790-3022 Ph: (626) 337-2888 |
| NPI Number | 1699955575 |
|---|---|
| Provider Enumeration Date | 11/08/2007 |
| Last Update Date | 03/11/2009 |
| Medicare PECOS PAC ID | 2466415823 |
|---|---|
| Medicare Enrollment ID | O20041105001040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699955575 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| Provider Name | Miguel I Domingo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538248166 PECOS PAC ID: 8628031093 Enrollment ID: I20041105001069 |
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