NPIMap

Organization Active NPI

La Libertad Medical Clinic Inc

  • General Practice Physician
  • South Gate, CA
National Provider Identifier
1295887024
Registry record updated Sep 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A45384 Issued in CA
Legal business name
LA LIBERTAD MEDICAL CLINIC INC
Practice address
8225 Long Beach Blvd
Suite C
South Gate, CA 90280-2010
Phone
(323) 585-1056
NPI assigned
Jan 18, 2007
Last updated
Sep 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2016

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

Authorized official

Name
Dr. Ricardo E Chambi, MDNPI 1518905181
Title
President
Phone
(323) 585-1056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X A45384 CA Primary

Addresses

Primary practice location

8225 Long Beach Blvd
Suite C
South Gate, CA 90280-2010

Mailing address

PO Box 3429
Huntington Park, CA 90255-2329
Phone (323) 585-1056

Other identifiers 2

IdentifierTypeStateIssuer
GR0101040MedicaidCA
00A453841MedicaidCA

Other names 1

  • RICARDO E CHAMBI MD Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718000875 CA Part B Supplier - Clinic/Group Practice 1254368699 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
Practice locations: South Gate, CA; Walnut Park, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0918737La Libertad Medical Clinic8225 Long Beach Blvd, South Gate, CA 90280Certificate of waiverDec 23, 2026

National Provider Directory

National Provider Directory

Locations

8225 Long Beach Blvd
#C
South Gate, CA 90280
Phone (323) 585-1056

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474675200000",
    "number": "1295887024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3429",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552329",
            "telephone_number": "323-585-1056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8225 LONG BEACH BLVD",
            "address_2": "SUITE C",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902802010",
            "telephone_number": "323-585-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA LIBERTAD MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2016-09-24",
        "status": "A",
        "authorized_official_last_name": "CHAMBI",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-585-1056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A45384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0101040",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A453841",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RICARDO E CHAMBI MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Gate, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.