| Evchc - Willow Center | |
|
14101 Nelson Ave La Puente CA 91746-2640 | |
| (626) 919-4333 | |
| (626) 919-2084 |
| Full Name | Evchc - Willow Center |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 14101 Nelson Ave, La Puente, 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 |
|---|---|
| Evchc - Willow Center 420 S Glendora Ave West Covina CA 91790-3001 Ph: (626) 919-4333 | Evchc - Willow Center 14101 Nelson Ave La Puente CA 91746-2640 Ph: (626) 919-4333 |
| NPI Number | 1598007197 |
|---|---|
| Provider Enumeration Date | 03/21/2013 |
| Last Update Date | 03/21/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598007197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 960000210 (California) | Primary |
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