Clinica El Lago Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

A76417 Issued in CA

Legal business name

CLINICA EL LAGO INC

Doing business as

Clinica el Lago

Practice address

101 N Palm St
Woodlake, CA 93286-1422

Phone

(559) 564-1100

Fax

(559) 564-1101

NPI assigned

Aug 19, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mario A Ochoa, MDNPI 1851393615

Title

Owner/Medical Director

Phone

(559) 564-1100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Clinica el Lago Doing business as
• CLINICA EL LAGO Inc Former legal business name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Erick Madrigal, MD, Mba Inc.

  dba Clinica Agua Viva-Woodlake

  • Family Medicine Physician
  • Woodlake, CA
  • NPI 1174237135

  Sold to, 2022-12-28

  CMS change of ownership

Practitioners 1

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.

• Mario Alberto Ochoa, M.D.

  • Family Medicine Physician
  • Selma, CA
  • NPI 1851393615
  NPD Authorized official

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

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386077857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N PALM ST",
            "city": "WOODLAKE",
            "state": "CA",
            "postal_code": "932861422",
            "telephone_number": "559-564-1100",
            "fax_number": "559-564-1101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 N PALM ST",
            "city": "WOODLAKE",
            "state": "CA",
            "postal_code": "932861422",
            "telephone_number": "559-564-1100",
            "fax_number": "559-564-1101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA EL LAGO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OCHOA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "559-564-1100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "A76417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6805241",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinica el Lago",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CLINICA EL LAGO Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jamie Nhung Bui
• Jose Luis Campos, MD
• Robert Castaneda, PHARM.D.
• Lizette Guadalupe Castillo Alvarez
• Manuel Castro
• Alma Ceja Corvera, P.A.
• Corey Crooks, PA-C
• Aimee Day, MS
• Erick Madrigal, MD, Mba Inc. (Clinica Agua Viva-Woodlake)
• Stephanie Corann Eskew, CMT

• Rural Health Clinic/Center in Woodlake, CA
• Providers in Woodlake, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.