San Manuel Medical Clinic, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A44599 Issued in CA

Legal business name

SAN MANUEL MEDICAL CLINIC, INC

Doing business as

Phillip Ruiz

Practice address

7400 Pacific Blvd
A
Huntington Park, CA 90255-5739

Phone

(323) 584-8881

Fax

(323) 584-8882

NPI assigned

Jun 23, 2011

Last updated

Aug 11, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

MULTI-CULTURAL MEDICAL CENTER, INCAs reported in NPPES

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

Authorized official

Name

Phillip A Ruiz, M,D

Title

Director

Phone

(323) 584-8881

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• PHILLIP RUIZ Doing business as

Part of

San Manuel Medical Center

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1902192362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD",
            "address_2": "SUITE# A-B",
            "city": "WALNUT PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-584-8881",
            "fax_number": "323-584-8882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 PACIFIC BLVD",
            "address_2": "A",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902555739",
            "telephone_number": "323-584-8881",
            "fax_number": "323-584-8882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MANUEL MEDICAL CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MULTI-CULTURAL MEDICAL CENTER, INC",
        "enumeration_date": "2011-06-23",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "323-584-8881",
        "authorized_official_credential": "M,D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A30390",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A44599",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A41503",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15560",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-SPECIALTY GROUP-PHYSICIAN ASSISTANT",
            "identifier": "PA15560",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-SPECIALTY GROUP- FAMILY MEDICINE",
            "identifier": "A44599",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHILLIP RUIZ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Huntington Park, CA
• Providers in Huntington Park, 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 Aug 11, 2011; 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.