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12462 Putnam Street Whittier CA 90602 | |
| (562) 698-0811 | |
| (562) 698-6238 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 12462 Putnam Street, Whittier, California |
| Authorized Official Name and Position | Sue R Ponce (aka Carlson) (SPECIAL PROJECTS) |
| Authorized Official Contact | 5626980811 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12401 Washington Blvd Whittier CA 90602-1006 Ph: (562) 698-0811 | 12462 Putnam Street Whittier CA 90602 Ph: (562) 698-0811 |
| NPI Number | 1235372459 |
|---|---|
| Provider Enumeration Date | 04/17/2009 |
| Last Update Date | 07/26/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235372459 | NPI | - | NPPES |
| ZZT40169F | Medicaid | CA | |
| HSC30169F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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