Clinica Medica Centro Hispano Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A53766 Issued in CA

Legal business name

CLINICA MEDICA CENTRO HISPANO INC

Practice address

360 E 7TH St Ste H
Upland, CA 91786-6701

Phone

(909) 985-8031

Fax

(909) 985-8182

NPI assigned

Nov 20, 2007

Organization subpart

No

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

Authorized official

Name

Miguel I Domingo, MDNPI 1538248166

Title

Director

Phone

(909) 467-1445

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miguel Isleta Domingo, M.D.

  • Pediatrics Physician
  • West Covina, CA
  • NPI 1538248166

  Family Medicine

  Medicare reassignment NPD Authorized official
• Victor Manuel Campos, FNP

  • Nurse Practitioner
  • Upland, CA
  • NPI 1710034350
  NPD

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1730360579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST STE H",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-985-8031",
            "fax_number": "909-985-8182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E 7TH ST STE H",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917866701",
            "telephone_number": "909-985-8031",
            "fax_number": "909-985-8182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA MEDICA CENTRO HISPANO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-20",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "DOMINGO",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "909-467-1445",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A53766",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A53766",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ53072Y",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730360579",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alejandra Clark, M.D
• Katherine Marie Clark, DC
• Matthew Clark
• Ingrid Jacqueline Clignett, CATC I
• Clinica Guadalupana de Ontario Med GRP
• Colin Cochran
• Cheryl Yvette Colbert
• Malik Roshon Coleman
• Ted Coleman, PHD, MS
• Alan Collins

• Family Medicine Physician in Upland, CA
• Providers in Upland, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.