Organization
CLINICA MEDICA CENTRO HISPANO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIGUEL I DOMINGO MD (DIRECTOR)
(909) 467-1445
Entity
Organization
Contact information
Practice address
360 E 7TH ST STE H, UPLAND, CA 91786-6701
(909) 985-8031
(909) 985-8182
Mailing address
360 E 7TH ST STE H, UPLAND, CA 91786-6701
(909) 985-8031
(909) 985-8182
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A53766
CA
208000000X
Pediatrics Physician
A53766
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730360579
—
CA
01
—
ZZZ53072Y
BLUE SHIELD
CA
Enumeration date
11/20/2007
Last updated
09/14/2023
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