| United Community Clinic | |
|
714 N Avalon Blvd Wilmington CA 90744-5809 | |
| (310) 745-1343 | |
| (310) 522-4224 |
| Full Name | United Community Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 714 N Avalon Blvd, Wilmington, California |
| Authorized Official Name and Position | Romeo Herrera (ADMINISTRATOR) |
| Authorized Official Contact | 3104079331 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| United Community Clinic 714 N Avalon Blvd Wilmington CA 90744-5809 Ph: (310) 745-1343 | United Community Clinic 714 N Avalon Blvd Wilmington CA 90744-5809 Ph: (310) 745-1343 |
| NPI Number | 1437997855 |
|---|---|
| Provider Enumeration Date | 07/18/2024 |
| Last Update Date | 11/13/2024 |
| Certification Date | 11/13/2024 |
| Medicare PECOS PAC ID | 8325550684 |
|---|---|
| Medicare Enrollment ID | O20250623002437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437997855 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Leilani Rhea F Diego |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417372426 PECOS PAC ID: 1052636024 Enrollment ID: I20150216000153 |
| Provider Name | Valentin De Anda |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1578237327 PECOS PAC ID: 4486014347 Enrollment ID: I20230724003338 |
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