| Antonio Hurtado Rodriguez, M.d., A Professional Corporation | |
|
630 N Park Ave Pomona CA 91768-3621 | |
| (909) 622-3700 | |
| (909) 622-3744 |
| Full Name | Antonio Hurtado Rodriguez, M.d., A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 630 N Park Ave, Pomona, California |
| Authorized Official Name and Position | Antonio Hurtado Rodriguez (CEO) |
| Authorized Official Contact | 9096223700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Antonio Hurtado Rodriguez, M.d., A Professional Corporation 630 N Park Ave Pomona CA 91768-3621 Ph: (909) 622-3700 | Antonio Hurtado Rodriguez, M.d., A Professional Corporation 630 N Park Ave Pomona CA 91768-3621 Ph: (909) 622-3700 |
| NPI Number | 1891003869 |
|---|---|
| Provider Enumeration Date | 09/23/2010 |
| Last Update Date | 02/02/2020 |
| Medicare PECOS PAC ID | 2163548249 |
|---|---|
| Medicare Enrollment ID | O20100927000275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891003869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A109646 (California) | Primary |
| Provider Name | Antonio Hurtado Rodriguez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255587820 PECOS PAC ID: 5496871576 Enrollment ID: I20100927000351 |
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