Lourdes G Bahamonde DO Inc
Organization Active NPI Medical Specialty Clinic/Center · Cudahy, CA
NPI 1609533587 · NPPES record last updated Nov 30, 2021
Key facts
- NPI
- 1609533587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medical Specialty Clinic/Center 261QM2500X
- Legal business name
- LOURDES G BAHAMONDE DO INC
- Practice address
- 7643 Atlantic Ave
Cudahy, CA 90201-5019 - Phone
- (213) 373-1265
- NPI assigned
- Nov 26, 2021
- Organization subpart
- No
Authorized official
- Name
- Dr. Lourdes G Bahamonde, D.O.
- Title
- Ceo
- Phone
- (516) 526-9192
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220127001335 | CA | Part B Supplier - Clinic/Group Practice | 2567854367 |
Receives reassigned benefits from 1 practitioner Practice locations: Cudahy, CA |
National Provider Directory
Locations
1360 S Figueroa St
Ste D
Los Angeles, CA 90015
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | Yes | ||
| Primary Care Clinic/Center | 261QP2300X |
Addresses
Primary practice location
7643 Atlantic Ave
Cudahy, CA 90201-5019
Mailing address
147 N Mayflower Ave
Monrovia, CA 91016-2005
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All providers in Cudahy, CA · Medical Specialty Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.