| Clinica Medica Centro Hispano Inc | |
|
360 E 7th St Ste H Upland CA 91786-6701 | |
| (909) 985-8031 | |
| (909) 985-8182 |
| Full Name | Clinica Medica Centro Hispano Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 360 E 7th St Ste H, Upland, California |
| Authorized Official Name and Position | Miguel I Domingo (DIRECTOR) |
| Authorized Official Contact | 9094671445 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Centro Hispano Inc 360 E 7th St Ste H Upland CA 91786-6701 Ph: (909) 985-8031 | Clinica Medica Centro Hispano Inc 360 E 7th St Ste H Upland CA 91786-6701 Ph: (909) 985-8031 |
| NPI Number | 1730360579 |
|---|---|
| Provider Enumeration Date | 11/20/2007 |
| Last Update Date | 09/14/2023 |
| Medicare PECOS PAC ID | 5092897892 |
|---|---|
| Medicare Enrollment ID | O20080201000326 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730360579 | NPI | - | NPPES |
| ZZZ53072Y | Other | CA | BLUE SHIELD |
| 1730360579 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A53766 (California) | Primary |
| 208000000X | Pediatrics | A53766 (California) | 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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