NPIMap

Organization Active NPI

San Manuel Medical Clinic Inc.

  • Specialist
  • Walnut Park, CA
National Provider Identifier
1194071225
Registry record updated Jul 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A30390 Issued in CA
Legal business name
SAN MANUEL MEDICAL CLINIC INC.
Practice address
7400 Pacific Blvd
Ste a
Walnut Park, CA 90255-5739
Phone
(323) 584-8881
Fax
(323) 584-8882
NPI assigned
Jul 26, 2012
Last updated
Jul 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Anjana Sura, M.D.
Title
Director
Phone
(323) 584-8881

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A30390 CA Primary

Addresses

Primary practice location

7400 Pacific Blvd
Ste a
Walnut Park, CA 90255-5739

Mailing address

7400 Pacific Blvd
Ste a
Walnut Park, CA 90255-5739
Phone (323) 584-8881

National Provider Directory

National Provider Directory
Tax ID family
San Manuel Medical Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7400 Pacific Blvd
Ste A
Walnut Park, CA 90255
Phone (323) 583-9050

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343260800000",
    "number": "1194071225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD",
            "address_2": "STE A",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-584-8881",
            "fax_number": "323-584-8882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD",
            "address_2": "STE A",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-584-8881",
            "fax_number": "323-584-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MANUEL MEDICAL CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-26",
        "last_updated": "2012-07-26",
        "status": "A",
        "authorized_official_last_name": "SURA",
        "authorized_official_first_name": "ANJANA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "323-584-8881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A30390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.