| Clinica Medica Familiar-phn, Inc | |
|
280 N Riverside Ave Rialto CA 92376-5924 | |
| (909) 421-2121 | |
| (909) 421-0491 |
| Full Name | Clinica Medica Familiar-phn, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 280 N Riverside Ave, Rialto, California |
| Authorized Official Name and Position | Esteban Guerrero (C.O.O) |
| Authorized Official Contact | 9514294086 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinica Medica Familiar-phn, Inc 9792 Sierra Ave Fontana CA 92335-6717 Ph: (909) 434-6000 | Clinica Medica Familiar-phn, Inc 280 N Riverside Ave Rialto CA 92376-5924 Ph: (909) 421-2121 |
| NPI Number | 1275656761 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 9133289366 |
|---|---|
| Medicare Enrollment ID | O20240506004055 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275656761 | NPI | - | NPPES |
| GR0082770 | Other | CA | MEDI-CAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ela Grigorian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598937468 PECOS PAC ID: 9537222179 Enrollment ID: I20090108000484 |
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