| Su Clinica Medica Medical Group | |
|
850 W Highland Ave Suite A San Bernardino CA 92405-3855 | |
| (909) 886-7576 | |
| (909) 882-4921 |
| Full Name | Su Clinica Medica Medical Group |
|---|---|
| Speciality | General Practice |
| Location | 850 W Highland Ave, San Bernardino, California |
| Authorized Official Name and Position | Gabriel Pulgarin (CLINIC ADMISTRATOR) |
| Authorized Official Contact | 9098867576 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Su Clinica Medica Medical Group 850 W Highland Ave Suite A San Bernardino CA 92405-3855 Ph: (909) 886-7576 | Su Clinica Medica Medical Group 850 W Highland Ave Suite A San Bernardino CA 92405-3855 Ph: (909) 886-7576 |
| NPI Number | 1235589086 |
|---|---|
| Provider Enumeration Date | 06/13/2016 |
| Last Update Date | 02/21/2020 |
| Medicare PECOS PAC ID | 3375821440 |
|---|---|
| Medicare Enrollment ID | O20161024002251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235589086 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A101657 (California) | Primary |
| Provider Name | Jose A De La Llana |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1326244062 PECOS PAC ID: 6709941784 Enrollment ID: I20140918001961 |
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