NPIMap

Organization Active NPI

San Manuel Medical Clinic,Inc

  • Specialist
  • Walnut Park, CA
National Provider Identifier
1831456482
Registry record updated Apr 20, 2012
On this page

Key facts

NPPES NPI Registry
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
Last updated
Apr 20, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2012

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

Authorized official

Name
Elia Webb
Title
Office Manager
Phone
(323) 585-8881

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X A84082 CA Primary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X

Addresses

Primary practice location

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

Mailing address

7400 Pacific Blvd Ste a
Walnut Park, CA 90255-5739
Phone (323) 585-8881

National Provider Directory

National Provider Directory
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.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Park, CA

Sources for this page

  • 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.