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140 N Orange Ave. Suite 100 West Covina CA 91790-2032 | |
| (626) 800-1200 | |
| (626) 962-2471 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 140 N Orange Ave., West Covina, California |
| Authorized Official Name and Position | Erica Carbajal (SITE MANAGER) |
| Authorized Official Contact | 6268001200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
140 N Orange Ave. Suite 100 West Covina CA 91790-2032 Ph: (626) 800-1200 | 140 N Orange Ave. Suite 100 West Covina CA 91790-2032 Ph: (626) 800-1200 |
| NPI Number | 1003188160 |
|---|---|
| Provider Enumeration Date | 02/06/2012 |
| Last Update Date | 09/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003188160 | NPI | - | NPPES |
| 6409040 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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