| La Puente Sub Center | |
|
15930 Central Ave La Puente CA 91744-5410 | |
| (626) 579-8302 | |
| Not Available |
| Full Name | La Puente Sub Center |
|---|---|
| Speciality | Clinic/center |
| Location | 15930 Central Ave, La Puente, California |
| Authorized Official Name and Position | Mark Corbet (INTERIM CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 3232262400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Puente Sub Center 15930 Central Ave La Puente CA 91744-5410 Ph: (626) 579-8302 | La Puente Sub Center 15930 Central Ave La Puente CA 91744-5410 Ph: (626) 579-8302 |
| NPI Number | 1144499799 |
|---|---|
| Provider Enumeration Date | 02/28/2008 |
| Last Update Date | 03/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144499799 | NPI | - | NPPES |
| ZZW16100F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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