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420 S Glendora Ave West Covina CA 91790-3001 | |
| (626) 919-5724 | |
| (909) 623-9648 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 420 S Glendora Ave, West Covina, California |
| Authorized Official Name and Position | Alicia Mardini (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6269194333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
420 S Glendora Ave West Covina CA 91790-3001 Ph: (626) 919-5724 | 420 S Glendora Ave West Covina CA 91790-3001 Ph: (626) 919-5724 |
| NPI Number | 1053437509 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053437509 | NPI | - | NPPES |
| HAP12048F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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