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Organization
LA PROVIDENCIA IPA, INC.
Active
Organization
LA PROVIDENCIA IPA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WOSK (SECRETARY)
(562) 463-0172
Entity
Organization
Contact information
Practice address
14342 RAMONA BLVD, BALDWIN PARK, CA 91706-3241
(562) 463-0172
Mailing address
14342 RAMONA BLVD, BALDWIN PARK, CA 91706-3241
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
45086
CA
207Q00000X
Family Medicine Physician
71133
CA
207R00000X
Internal Medicine Physician
Primary
56374
CA
Other
Enumeration date
08/02/2017
Last updated
10/26/2017
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