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Organization
CLINICA MEDICA CENTRO LASER HISPANO INC.
Active
Organization
CLINICA MEDICA CENTRO LASER HISPANO INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC RIFKIN MA (DIRECTOR)
(909) 467-1445
Entity
Organization
Contact information
Practice address
1341 E 4TH ST, UNIT B, ONTARIO, CA 91764-3034
(909) 467-1445
(909) 467-1446
Mailing address
1341 E 4TH ST, UNIT B, ONTARIO, CA 91764-3034
(909) 467-1445
(909) 467-1446
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A32553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A325530
BLUE CROSS BLUE SHIELD
CA
Enumeration date
02/21/2007
Last updated
08/22/2020
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