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Organization
MODERN CONCEPTS MEDICAL GROUP
Active
Organization
MODERN CONCEPTS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARET HERRERA MD (PRESIDENT)
(323) 728-6070
Entity
Organization
Contact information
Practice address
50 BELLEFONTAINE ST, 404, PASADENA, CA 91105-3132
(323) 728-6070
(323) 728-2912
Mailing address
PO BOX 640, MONTEBELLO, CA 90640-0640
(323) 728-6070
(323) 728-2912
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0936983
CLIA WAIVER
CA
01
—
1346358827
MD
CA
05
—
6495234
—
CA
05
—
GR0084064
—
CA
Enumeration date
05/11/2007
Last updated
07/21/2022
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