Organization
CASA GUADALUPE FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY GARRETT (OWNER)
(213) 923-4074
Entity
Organization
Contact information
Practice address
2015 W 1ST ST STE K, SANTA ANA, CA 92703-3516
(714) 547-7745
Mailing address
2015 W. 1ST SUITE K, SANTA ANA, CA 92703
(714) 547-7745
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
166649
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063230
—
CA
Enumeration date
02/20/2007
Last updated
02/12/2008
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