# CENTRO MEDICO DEL CARMEN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821532508
- **Authorized official:** ANA ROSA ASCENCIO CLEC.MA (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (213) 219-8054

## Contact information

- **Practice address:** 13373 PERRIS BLVD, SUITE C202A, MORENO VALLEY, CA 92553-5441
- **Practice address phone:** (951) 242-8155
- **Practice address fax:** (951) 242-8311
- **Mailing address:** 13373 PERRIS BLVD, SUITE C202A, MORENO VALLEY, CA 92553-5441
- **Mailing address phone:** (951) 242-8155
- **Mailing address fax:** (951) 242-8311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A52193 | CA | Yes |

## Other

- **Enumeration date:** 12/14/2016
- **Last updated:** 12/14/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00521930 | — | CA |
| 01 | — | W19646 | MEDICARE ID: | CA |