NPI 1447445200

Clinica Medica San Miguel Ipa, a Medical Group, INC.

Organisation Exclusive Provider Organization San Marino, CA

Practice location

Address: 2360 Huntington Dr STE 201, San Marino, CA 91108-2651
Phone: (626) 656-2370
Fax: (626) 248-9060

Authorised official

Name: Lan N Pham
Title: Administrator
Phone: (626) 656-2370

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

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Registry record

NPI: 1447445200
Entity type: Organization
NPI issued: 13 Sep 2007
Record last updated: 13 Sep 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.