| Nogales Medical Clinic, Inc. | |
|
1840 N Hacienda Blvd Ste 10 La Puente CA 91744-1143 | |
| (626) 931-6618 | |
| (626) 931-6610 |
| Full Name | Nogales Medical Clinic, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 1840 N Hacienda Blvd Ste 10, La Puente, California |
| Authorized Official Name and Position | Lorenzo M Vazquez (PRESIDENT/CEO) |
| Authorized Official Contact | 6269316618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nogales Medical Clinic, Inc. 1840 N Hacienda Blvd Ste 10 La Puente CA 91744-1143 Ph: (626) 931-6618 | Nogales Medical Clinic, Inc. 1840 N Hacienda Blvd Ste 10 La Puente CA 91744-1143 Ph: (626) 931-6618 |
| NPI Number | 1497889810 |
|---|---|
| Provider Enumeration Date | 03/15/2007 |
| Last Update Date | 04/12/2021 |
| Medicare PECOS PAC ID | 3173551512 |
|---|---|
| Medicare Enrollment ID | O20071001000349 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497889810 | NPI | - | NPPES |
| 00A703840 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | A70384 (California) | Secondary |
| Provider Name | Lorenzo M Vazquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760521322 PECOS PAC ID: 2264417609 Enrollment ID: I20040621001272 |
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