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Organization
WEST COVINA MEDICAL GROUP, INC.
Active
Organization
WEST COVINA MEDICAL GROUP, INC.
Active
Other names
West Covina Medical Clinic, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LONGLEY (COO)
(626) 960-8614
Entity
Organization
Contact information
Practice address
1135 S SUNSET AVE STE 100, WEST COVINA, CA 91790-3938
(626) 960-8614
(626) 960-8624
Mailing address
1135 S SUNSET AVE STE 100, WEST COVINA, CA 91790-3938
(626) 960-8614
(626) 960-8624
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
CA
363A00000X
Physician Assistant
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ32579Z
MEDICAL
CA
Enumeration date
10/13/2006
Last updated
09/11/2025
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