| Hesperia Clinica Medica Familiar A Medical Corporation | |
|
15888 Main St Suite 112b Hesperia CA 92345-3467 | |
| (760) 948-2242 | |
| (760) 948-6244 |
| Full Name | Hesperia Clinica Medica Familiar A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 15888 Main St, Hesperia, California |
| Authorized Official Name and Position | Octavio Ruiz-villalpando (OWNER/PRESIDENT) |
| Authorized Official Contact | 7609482242 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hesperia Clinica Medica Familiar A Medical Corporation 15888 Main St Suite 112b Hesperia CA 92345-3467 Ph: (760) 948-2242 | Hesperia Clinica Medica Familiar A Medical Corporation 15888 Main St Suite 112b Hesperia CA 92345-3467 Ph: (760) 948-2242 |
| NPI Number | 1164728788 |
|---|---|
| Provider Enumeration Date | 01/28/2011 |
| Last Update Date | 07/13/2012 |
| Medicare PECOS PAC ID | 1951521186 |
|---|---|
| Medicare Enrollment ID | O20141009002062 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164728788 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A92039 (California) | Primary |
| Provider Name | Octavio Ruiz Villalpando |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194832816 PECOS PAC ID: 3870691926 Enrollment ID: I20070613000358 |
| Provider Name | Sandra Limon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316493406 PECOS PAC ID: 1052687928 Enrollment ID: I20171019002782 |
| Provider Name | Don Qui Pham |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1992184998 PECOS PAC ID: 0749588036 Enrollment ID: I20180111002175 |
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