| Harbor Community Clinic | |
|
593 W 6th St San Pedro CA 90731-2521 | |
| (310) 547-0202 | |
| (310) 547-5096 |
| Full Name | Harbor Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 593 W 6th St, San Pedro, California |
| Authorized Official Name and Position | Tamra King (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 3105478241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Harbor Community Clinic 593 W 6th St San Pedro CA 90731-2521 Ph: (310) 547-0202 | Harbor Community Clinic 593 W 6th St San Pedro CA 90731-2521 Ph: (310) 547-0202 |
| NPI Number | 1467490425 |
|---|---|
| Provider Enumeration Date | 06/03/2006 |
| Last Update Date | 02/08/2022 |
| Certification Date | 02/07/2022 |
| Medicare PECOS PAC ID | 8022166826 |
|---|---|
| Medicare Enrollment ID | O20090505000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467490425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 960000085 (California) | Primary |
| 171M00000X | Case Manager/care Coordinator | (NU) | Secondary |
| Provider Name | Shribala Kumar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003934423 PECOS PAC ID: 1254359581 Enrollment ID: I20051104000798 |
| Provider Name | Hind Bennani |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1073702213 PECOS PAC ID: 0941381875 Enrollment ID: I20080117000249 |
| Provider Name | Kevin I Metzger |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689847725 PECOS PAC ID: 2961562624 Enrollment ID: I20081125000651 |
| Provider Name | Dianne E Bohorquez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467617142 PECOS PAC ID: 3274699509 Enrollment ID: I20090311000323 |
| Provider Name | Michael T Montecillo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174779425 PECOS PAC ID: 7012206600 Enrollment ID: I20160520001879 |
| Provider Name | Evelyn M Desser |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255459129 PECOS PAC ID: 9931337078 Enrollment ID: I20170228001967 |
| Provider Name | Min S Pan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1891254884 PECOS PAC ID: 5193050896 Enrollment ID: I20190717003707 |
| Provider Name | Warren T Yamashita |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982137691 PECOS PAC ID: 3678993433 Enrollment ID: I20201015002454 |
| Provider Name | Cristhiam a Santos |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1124618186 PECOS PAC ID: 6204235518 Enrollment ID: I20210518002729 |
| Provider Name | Belinda Kim Khou |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1659980233 PECOS PAC ID: 4082024500 Enrollment ID: I20210812001279 |
| Provider Name | Caleb Matthew Lusk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386149912 PECOS PAC ID: 8325441058 Enrollment ID: I20220914003787 |
| Provider Name | Suneun S Reichert |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083031769 PECOS PAC ID: 0749666089 Enrollment ID: I20221010002690 |
| Provider Name | Veronica E Aguilar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588169007 PECOS PAC ID: 9739583881 Enrollment ID: I20221022000225 |
| Provider Name | Foya S Tavangary |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831826106 PECOS PAC ID: 8224408034 Enrollment ID: I20230111002297 |
| Provider Name | Yen Nguyen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255047957 PECOS PAC ID: 9931574894 Enrollment ID: I20230405003043 |
| Provider Name | Anthony I Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669722708 PECOS PAC ID: 1951753078 Enrollment ID: I20240114000014 |
| Provider Name | Jeffrey a Ramirez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1568090132 PECOS PAC ID: 1355794538 Enrollment ID: I20240124004010 |
| Provider Name | Mayra Perez Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1215286950 PECOS PAC ID: 3779927397 Enrollment ID: I20240221004163 |
| Provider Name | Oluwafemisayo Akinnagbe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316567043 PECOS PAC ID: 9638517006 Enrollment ID: I20240403004323 |
| Provider Name | Jin Gyo Jung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669226478 PECOS PAC ID: 0840730594 Enrollment ID: I20240909001523 |
| Provider Name | Joseph Gancayco |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1366070815 PECOS PAC ID: 9739620444 Enrollment ID: I20240923000169 |
| Provider Name | Jesse Duro |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417720376 PECOS PAC ID: 7911429022 Enrollment ID: I20250318003341 |
Ramin Alizadeh MD Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1534 W 25th St, San Pedro, CA 90732 Phone: 310-547-3034 Fax: 310-548-5242 |
Mark Perez MD Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1350 W 6th St, 2nd Floor #7, San Pedro, CA 90732 Phone: 310-832-1126 Fax: 310-831-3000 |
Jeremy Anuntiyo MD Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1360 W 6th St Ste 310, San Pedro, CA 90732 Phone: 562-529-7772 Fax: 562-529-5449 |
Multicare Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 505 S Pacific Ave, Suite #201, San Pedro, CA 90731 Phone: 424-570-6960 Fax: 424-570-6952 |
Dr Mona Shah Professional Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1600 S Gaffey St, San Pedro, CA 90731 Phone: 310-548-0201 Fax: 310-547-3340 |
Total Body Advanced Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 789 W 9th St, San Pedro, CA 90731 Phone: 310-519-1557 Fax: 310-519-0330 |