| Zacoalco Medical Group Inc | |
|
5901 Niles St A Bakersfield CA 93306-4780 | |
| (166) 136-3723 | |
| Not Available |
| Full Name | Zacoalco Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 5901 Niles St, Bakersfield, California |
| Authorized Official Name and Position | Saul De La Rosa (PRESIDENT) |
| Authorized Official Contact | 3235881383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Zacoalco Medical Group Inc 5901 Niles St A Bakersfield CA 93306-4780 Ph: (166) 163-6723 | Zacoalco Medical Group Inc 5901 Niles St A Bakersfield CA 93306-4780 Ph: (166) 136-3723 |
| NPI Number | 1679626170 |
|---|---|
| Provider Enumeration Date | 01/19/2007 |
| Last Update Date | 03/09/2018 |
| Medicare PECOS PAC ID | 4183667629 |
|---|---|
| Medicare Enrollment ID | O20050606001247 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679626170 | NPI | - | NPPES |
| GR0080241 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G75144 (California) | Primary |
| 207V00000X | Obstetrics & Gynecology | (California) | Secondary |
| Provider Name | Raymond M Menchaca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851339089 PECOS PAC ID: 5092756205 Enrollment ID: I20050518000677 |
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