Organization
CLINICA MEDICA CENTRO LASER HISPANO INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARC RIFKIN MA (DIRECTOR)
(909) 467-1445
Entity
Organization
Contact information
Practice address
1341 E 4TH ST, UNIT B, ONTARIO, CA 91764-3034
(909) 467-1445
(909) 467-1446
Mailing address
1341 E 4TH ST, UNIT B, ONTARIO, CA 91764-3034
(909) 467-1445
(909) 467-1446
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A32553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A325530
BLUE CROSS BLUE SHIELD
CA
Enumeration date
02/21/2007
Last updated
08/22/2020
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