Basic Information
| Provider Information | |||||||||
| NPI: | 1427155597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICA DE SALUD MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 W CENTRAL AVE | ||||||||
| Address2: | STE 107 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927073165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145574080 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 W CENTRAL AVE | ||||||||
| Address2: | STE 107 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927073165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145574080 | ||||||||
| FaxNumber: | 7145572251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 02/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARPIO-CEDRARO | ||||||||
| AuthorizedOfficialFirstName: | FELIX | ||||||||
| AuthorizedOfficialMiddleName: | FRANCISCO | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 7145574080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., M.P.H. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A53568 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0071720 | 05 | CA | MEDICAID |