Organization
MAYWOOD HEALTHCARE CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REY QUINONEZ PA-C (ADMINISTRATOR)
(323) 861-1510
Entity
Organization
Contact information
Practice address
4205 SLAUSON AVE, MAYWOOD, CA 90270-2835
(323) 560-0118
(323) 560-1302
Mailing address
4205 SLAUSON AVE, MAYWOOD, CA 90270-2835
(323) 560-0118
(323) 560-1302
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
A70433
CA
261QP2300X
Primary Care Clinic/Center
Primary
A70433
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A70433
MD CA LIC #
CA
01
—
PA1756
PA-C CA LIC #
CA
01
—
PA19411
PA-C CA LIC #
CA
Enumeration date
09/23/2013
Last updated
09/03/2014
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