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501 S Brookhurst Rd Fullerton CA 92833-3207 | |
(714) 870-0717 | |
(714) 870-5468 |
Full Name | |
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Speciality | Clinic/Center |
Location | 501 S Brookhurst Rd, Fullerton, California |
Authorized Official Name and Position | Luz B Alamares (BILLING COORDINATOR) |
Authorized Official Contact | 7148700717 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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501 S Brookhurst Rd Fullerton CA 92833-3207 Ph: (714) 870-0717 | 501 S Brookhurst Rd Fullerton CA 92833-3207 Ph: (714) 870-0717 |
NPI Number | 1508977414 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 10/14/2011 |
Medicare PECOS PAC ID | 2961471982 |
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Medicare Enrollment ID | O20040927001170 |
Identifier | Type | State | Issuer |
---|---|---|---|
1508977414 | NPI | - | NPPES |
CMM70069G | Medicaid | CA | |
00A786420 | Medicaid | CA | |
CH05096 | Medicaid | CA | |
00A671101 | Medicaid | CA | |
EAP70069G | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 060000016 (California) | Primary |
Provider Name | Edgar Flores |
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Provider Type | Practitioner - Pediatric Medicine |
Provider Identifiers | NPI Number: 1992857239 PECOS PAC ID: 0749243103 Enrollment ID: I20041105001029 |
Provider Name | Diane Allen |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1700938941 PECOS PAC ID: 9234140088 Enrollment ID: I20060509000239 |
Provider Name | Frances Abigail Malantic |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1780018960 PECOS PAC ID: 5799902383 Enrollment ID: I20140805001355 |
Provider Name | Valerie Thi Van |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932585866 PECOS PAC ID: 7113235854 Enrollment ID: I20150930001383 |
Provider Name | Victor J Pinedo |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1306231576 PECOS PAC ID: 7315237369 Enrollment ID: I20160602001645 |
Provider Name | Vivien T Thach |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427416841 PECOS PAC ID: 6507156577 Enrollment ID: I20160602002269 |
Provider Name | Marjolyne Sales |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1942661772 PECOS PAC ID: 2567736002 Enrollment ID: I20170921001222 |
Provider Name | Jonathan Andrew Robinson |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1720618010 PECOS PAC ID: 9234537176 Enrollment ID: I20211018002078 |
Uma P Rao, Md., Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1400 N Harbor Blvd, Suite 120, Fullerton, CA 92835 Phone: 714-992-2765 Fax: 714-681-9015 | |