Organization
EVERGREEN IPA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORLANDO DONADIO MENDOZA CPCO (COMPLIANCE OFFICER)
(626) 943-7465
Entity
Organization
Contact information
Practice address
1032 S GARFIELD AVE, ALHAMBRA, CA 91801-4762
(626) 943-7465
(626) 458-8051
Mailing address
1032 S GARFIELD AVE, ALHAMBRA, CA 91801-4762
(626) 943-7465
(626) 458-8051
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
A34137
CA
Other
Enumeration date
04/25/2012
Last updated
03/07/2023
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