| San Miguel Community Clinic | |
|
825 N Park Ave Pomona CA 91768-3002 | |
| (909) 622-9988 | |
| (909) 622-3452 |
| Full Name | San Miguel Community Clinic |
|---|---|
| Speciality | General Practice |
| Location | 825 N Park Ave, Pomona, California |
| Authorized Official Name and Position | Kj Laessig (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2137420255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| San Miguel Community Clinic 825 N Park Ave Pomona CA 91768-3002 Ph: (909) 622-9988 | San Miguel Community Clinic 825 N Park Ave Pomona CA 91768-3002 Ph: (909) 622-9988 |
| NPI Number | 1942548342 |
|---|---|
| Provider Enumeration Date | 01/21/2013 |
| Last Update Date | 01/21/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942548342 | NPI | - | NPPES |
| GR0016851 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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