La Providencia Ipa, Inc. | |
14342 Ramona Blvd Baldwin Park CA 91706-3241 | |
(562) 463-0172 | |
Not Available |
Full Name | La Providencia Ipa, Inc. |
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Speciality | Internal Medicine |
Location | 14342 Ramona Blvd, Baldwin Park, California |
Authorized Official Name and Position | Samuel Wosk (SECRETARY) |
Authorized Official Contact | 5624630172 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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La Providencia Ipa, Inc. 14342 Ramona Blvd Baldwin Park CA 91706-3241 Ph: () - | La Providencia Ipa, Inc. 14342 Ramona Blvd Baldwin Park CA 91706-3241 Ph: (562) 463-0172 |
NPI Number | 1760906507 |
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Provider Enumeration Date | 08/02/2017 |
Last Update Date | 10/26/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1760906507 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 71133 (California) | Secondary |
207Q00000X | Family Medicine | 45086 (California) | Secondary |
207R00000X | Internal Medicine | 56374 (California) | Primary |
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