| Clinica Medica Nuestra | |
|
1403 N Fair Oaks Ave Suite 3 Pasadena CA 91103-1858 | |
| (626) 398-0354 | |
| (626) 398-0357 |
| Full Name | Clinica Medica Nuestra |
|---|---|
| Speciality | Family Medicine |
| Location | 1403 N Fair Oaks Ave, Pasadena, California |
| Authorized Official Name and Position | Carlos Rodriguez (DIRECTOR) |
| Authorized Official Contact | 6263980354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Nuestra 1403 N Fair Oaks Ave Suite 3 Pasadena CA 91103-1858 Ph: (626) 398-0354 | Clinica Medica Nuestra 1403 N Fair Oaks Ave Suite 3 Pasadena CA 91103-1858 Ph: (626) 398-0354 |
| NPI Number | 1255471868 |
|---|---|
| Provider Enumeration Date | 02/06/2007 |
| Last Update Date | 03/03/2020 |
| Medicare PECOS PAC ID | 7315934163 |
|---|---|
| Medicare Enrollment ID | O20040426001253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255471868 | NPI | - | NPPES |
| 00A565020 | Other | CA | INSURANCE |
| GR0100500 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A56502 (California) | Primary |
| Provider Name | Carlos Gustavo Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811046485 PECOS PAC ID: 4981691730 Enrollment ID: I20040427000830 |
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