| La Verne Family Medical Center Inc | |
|
2100 Foothill Blvd Suite A La Verne CA 91750-2905 | |
| (909) 596-1941 | |
| (909) 596-1943 |
| Full Name | La Verne Family Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2100 Foothill Blvd, La Verne, California |
| Authorized Official Name and Position | Tan Lin Wong (PRESIDENT) |
| Authorized Official Contact | 9095961941 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Verne Family Medical Center Inc 2100 Foothill Blvd Suite A La Verne CA 91750-2905 Ph: (909) 596-1941 | La Verne Family Medical Center Inc 2100 Foothill Blvd Suite A La Verne CA 91750-2905 Ph: (909) 596-1941 |
| NPI Number | 1457469884 |
|---|---|
| Provider Enumeration Date | 08/27/2006 |
| Last Update Date | 12/09/2011 |
| Medicare PECOS PAC ID | 3072616804 |
|---|---|
| Medicare Enrollment ID | O20070314000580 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457469884 | NPI | - | NPPES |
| W20443 | Other | CA | MEDICARE GROUP ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A50496 (California) | Primary |
| Provider Name | Tan L Wong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790728749 PECOS PAC ID: 2365437621 Enrollment ID: I20040416000402 |
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