| La Paz Medical Clinic, Inc | |
|
1345 Huntington Dr Duarte CA 91010-2527 | |
| (626) 359-8604 | |
| Not Available |
| Full Name | La Paz Medical Clinic, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1345 Huntington Dr, Duarte, California |
| Authorized Official Name and Position | Richard Berton Mantell (OWNER) |
| Authorized Official Contact | 6263598604 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| La Paz Medical Clinic, Inc 1345 Huntington Dr Duarte CA 91010-2527 Ph: (626) 359-8604 | La Paz Medical Clinic, Inc 1345 Huntington Dr Duarte CA 91010-2527 Ph: (626) 359-8604 |
| NPI Number | 1124452875 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 08/29/2013 |
| Medicare PECOS PAC ID | 4486873270 |
|---|---|
| Medicare Enrollment ID | O20140909002025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124452875 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A39992 (California) | Primary |
| Provider Name | Rubio R Punzalan |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1093937708 PECOS PAC ID: 0648166801 Enrollment ID: I20040302001416 |
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