Organization Name: | LA LIBERTAD MEDICAL CLINIC INC |
NPI Number: | 1245655240 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RICARDO E CHAMBI (DIRECTOR) |
Mailing Address: | 7900 Pacific Blvd Huntington Park |
State: | CA US |
Postal Code: | 902556662 |
Phone Number: | 3232779455 |
Fax Number: | 3232779450 |
NPI Enumeration Date: | 02/27/2014 |
NPI Last Update Date: | 02/27/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |