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Organization
FOOTHILL COMMUNITY MEDICAL CORPORATION
Active
Organization
FOOTHILL COMMUNITY MEDICAL CORPORATION
Active
Other names
San Rafael Community Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL CARCAMO M.D. (PRESIDENT)
(909) 865-2538
Entity
Organization
Contact information
Practice address
1126 W MISSION BLVD, POMONA, CA 91766-1342
(909) 865-2538
(909) 865-2508
Mailing address
1126 W MISSION BLVD, POMONA, CA 91766-1342
(909) 865-2538
(909) 865-2508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00A666750
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0090561
—
CA
Enumeration date
04/20/2007
Last updated
08/22/2020
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