San Miguel Community Clinic

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

SAN MIGUEL COMMUNITY CLINIC

Practice address

825 N Park Ave
Pomona, CA 91768-3002

Phone

(909) 622-9988

Fax

(909) 622-3452

NPI assigned

Jan 21, 2013

Organization subpart

Yes

Parent organization

THE SAN MIGUEL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Mr. KJ Laessig

Title

Executive Director

Phone

(213) 742-0255

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

San Miguel Community Clinic

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

{
    "created_epoch": "1358726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358726400000",
    "number": "1942548342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683002",
            "telephone_number": "909-622-9988",
            "fax_number": "909-622-3452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N PARK AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683002",
            "telephone_number": "909-622-9988",
            "fax_number": "909-622-3452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MIGUEL COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE SAN MIGUEL FOUNDATION",
        "enumeration_date": "2013-01-21",
        "last_updated": "2013-01-21",
        "status": "A",
        "authorized_official_last_name": "LAESSIG",
        "authorized_official_first_name": "KJ",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "213-742-0255",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0016851",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Briana Sample
• Marcus Daniel Sample
• Srinath Samudrala, M.D.
• San Antonio Pharmacy
• San Gabriel Pomona Regional Center
• San Miguel Urgent Care Pomona
• Sana Qureshi MD
• Sarah Elizabeth Sanasac
• Tatiana Sanchez Baires
• Celia Ariande Sanchez Casarez, M.D.

• General Practice Physician in Pomona, CA
• Providers in Pomona, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2013; 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.