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Organization
FOOTHILL COMMUNITY MEDICAL CORP.
Active
Organization
FOOTHILL COMMUNITY MEDICAL CORP.
Active
Other names
San Rafael Community Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFAEL CARCAMO M.D. (PRESIDENT)
(626) 858-5199
Entity
Organization
Contact information
Practice address
647 E ARROW HWY, AZUSA, CA 91702-5802
(626) 858-5199
(626) 858-5299
Mailing address
647 E ARROW HWY, AZUSA, CA 91702-5802
(626) 858-5199
(626) 858-5299
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A66675
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0090650
—
CA
Enumeration date
04/18/2007
Last updated
06/16/2016
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