Provider Demographics
NPI:1053964155
Name:HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC
Entity type:Organization
Organization Name:HUNTINGTON PARK CLINICA MEDICA GENERAL, MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA BACHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-637-2530
Mailing Address - Street 1:6347 PACIFIC BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4101
Mailing Address - Country:US
Mailing Address - Phone:323-583-8383
Mailing Address - Fax:323-583-8399
Practice Address - Street 1:6511 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1425
Practice Address - Country:US
Practice Address - Phone:818-901-9090
Practice Address - Fax:818-901-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty