Clinica Medica San Miguel Ipa, a Medical Group, Inc.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

CLINICA MEDICA SAN MIGUEL IPA, A MEDICAL GROUP, INC.

Practice address

2360 Huntington Dr Ste 201
San Marino, CA 91108-2651

Phone

(626) 656-2370

Fax

(626) 248-9060

NPI assigned

Sep 13, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Lan N Pham, MPH

Title

Administrator

Phone

(626) 656-2370

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1447445200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360 HUNTINGTON DR STE 201",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082651",
            "telephone_number": "626-656-2370",
            "fax_number": "626-248-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360 HUNTINGTON DR STE 201",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082651",
            "telephone_number": "626-656-2370",
            "fax_number": "626-248-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MEDICA SAN MIGUEL IPA, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "LAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "626-656-2370",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Warren Ritchie Christianson II, D.O.
• Chiao Wen Chuang, L.AC
• Paul Yun Hung Chung
• City of San Marino
• Claudia Rosenberg, PHD Licensed Clinical Social Worker PC
• Clinical Dietitian Solutions, LLC
• Sam Cohen Paz, MA, JD
• Amie Alonzo Cohen, AGPCNP-BC
• Melvin S Cohen, MD
• Rebekah Ponce Cohen, M.S., CCC-SLP

• All providers in San Marino, CA
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.