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647 E Arrow Hwy Azusa CA 91702-5802 | |
| (626) 858-5199 | |
| (626) 858-5299 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 647 E Arrow Hwy, Azusa, California |
| Authorized Official Name and Position | Rafael Carcamo (PRESIDENT) |
| Authorized Official Contact | 6268585199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
647 E Arrow Hwy Azusa CA 91702-5802 Ph: (626) 858-5199 | 647 E Arrow Hwy Azusa CA 91702-5802 Ph: (626) 858-5199 |
| NPI Number | 1881811404 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 06/16/2016 |
| Medicare PECOS PAC ID | 2567426810 |
|---|---|
| Medicare Enrollment ID | O20041116000816 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881811404 | NPI | - | NPPES |
| GR0090650 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A66675 (California) | Primary |
| Provider Name | Rafael Carcamo |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1821007055 PECOS PAC ID: 6901860261 Enrollment ID: I20041116001086 |
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