NPIMap

Organization Active NPI

La Libertad Medical Clinic Inc.

  • General Practice Physician
  • Walnut Park, CA
National Provider Identifier
1861882946
Registry record updated Sep 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LA LIBERTAD MEDICAL CLINIC INC.
Practice address
7900 Pacific Blvd
Suite C Thru F
Walnut Park, CA 90255-6662
Phone
(323) 277-9455
Fax
(562) 943-7518
NPI assigned
Jan 28, 2015
Last updated
Sep 24, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
LA LIBERTAD MEDICAL CLINIC INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 24, 2016

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

Authorized official

Name
Ricardo E Chambi, MDNPI 1518905181
Title
Director
Phone
(323) 585-1056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X CA Primary

Addresses

Primary practice location

7900 Pacific Blvd
Suite C Thru F
Walnut Park, CA 90255-6662

Mailing address

PO Box 3429
Huntington Park, CA 90255-2329
Phone (323) 277-9455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718000875 CA Part B Supplier - Clinic/Group Practice 1254368699 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: South Gate, CA; Walnut Park, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
La Libertad Medical Clinic3 organizations share this tax ID, including this one
Part of
La Libertad Medical Clinic

Other organizations with this tax ID 2

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

Locations

8225 Long Beach Blvd
South Gate, CA 90280
Phone (323) 585-1056

7900 Pacific Blvd
Ste C
Walnut Park, CA 90255
Phone (323) 277-9455

7900 Pacific Blvd
Ste E
Walnut Park, CA 90255
Phone (323) 585-1056

7900 Pacific Blvd
Ste F
Walnut Park, CA 90255
Phone (323) 585-1056

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1422403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474675200000",
    "number": "1861882946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3429",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552329",
            "telephone_number": "323-277-9455",
            "fax_number": "562-943-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 PACIFIC BLVD",
            "address_2": "SUITE C THRU F",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902556662",
            "telephone_number": "323-277-9455",
            "fax_number": "562-943-7518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA LIBERTAD MEDICAL CLINIC INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LA LIBERTAD MEDICAL CLINIC INC.",
        "enumeration_date": "2015-01-28",
        "last_updated": "2016-09-24",
        "status": "A",
        "authorized_official_last_name": "CHAMBI",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "323-585-1056",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "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 Sep 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.