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Organization
SAN MANUEL MEDICAL CLINIC,INC
Active
Organization
SAN MANUEL MEDICAL CLINIC,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIA WEBB (OFFICE MANAGER)
(323) 585-8881
Entity
Organization
Contact information
Practice address
7400 PACIFIC BLVD STE A, WALNUT PARK, CA 90255-5739
(323) 585-8881
Mailing address
7400 PACIFIC BLVD STE A, WALNUT PARK, CA 90255-5739
(323) 585-8881
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A84082
CA
207Q00000X
Family Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0100930
—
CA
Enumeration date
04/20/2012
Last updated
04/20/2012
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