Organization Name: | MD CLINIC, INC |
NPI Number: | 1770810624 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | FERNANDO PARTIDA-RUESGA (PRESIDENT) |
Mailing Address: | 14135 Cedar Ave Apple Valley |
State: | MN US |
Postal Code: | 551244522 |
Phone Number: | 9524319655 |
Fax Number: | 9524319651 |
NPI Enumeration Date: | 11/13/2009 |
NPI Last Update Date: | 11/24/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1245087 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |