Organization
CLINICA EL LAGO INC
Active
Other names
CLINICA EL LAGO Inc, Clinica el Lago
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO A OCHOA MD (OWNER/MEDICAL DIRECTOR)
(559) 564-1100
Entity
Organization
Contact information
Practice address
101 N PALM ST, WOODLAKE, CA 93286-1422
(559) 564-1100
(559) 564-1101
Mailing address
101 N PALM ST, WOODLAKE, CA 93286-1422
(559) 564-1100
(559) 564-1101
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
A76417
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6805241
—
CA
Enumeration date
08/19/2013
Last updated
07/21/2022
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