San Manuel Medical Clinic,Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A84082 Issued in CA

Legal business name

SAN MANUEL MEDICAL CLINIC,INC

Practice address

7400 Pacific Blvd Ste a
Walnut Park, CA 90255-5739

Phone

(323) 585-8881

NPI assigned

Apr 20, 2012

Organization subpart

No

Name

Elia Webb

Title

Office Manager

Phone

(323) 585-8881

Tax ID family

San Manuel Medical Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• San Manuel Medical Clinic Inc.

  • Specialist
  • Walnut Park, CA
  • NPI 1194071225
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 20, 2012.

{
    "created_epoch": "1334880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334880000000",
    "number": "1831456482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD STE A",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-585-8881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD STE A",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-585-8881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MANUEL MEDICAL CLINIC,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-20",
        "last_updated": "2012-04-20",
        "status": "A",
        "authorized_official_last_name": "WEBB",
        "authorized_official_first_name": "ELIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "323-585-8881"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A84082",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0100930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ariel Cruz Rodriguez
• Christian Alain Rodriguez
• Luis A Rosado
• Deborah Ruth Rosen, AMFT
• San Manuel Medical Clinic Inc.
• Sep Community Clinic
• Sura Pediatric Specialist, Inc
• Tammy Terry
• Tiffany Tinoco
• Erika Liliana Tobar Rodas

• All providers in Walnut Park, CA
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; 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.