Organization
CENTRO MEDICO DEL CARMEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANA ROSA ASCENCIO CLEC.MA (ADMINISTRATIVE ASSISTANT)
(213) 219-8054
Entity
Organization
Contact information
Practice address
13373 PERRIS BLVD, SUITE C202A, MORENO VALLEY, CA 92553-5441
(951) 242-8155
(951) 242-8311
Mailing address
13373 PERRIS BLVD, SUITE C202A, MORENO VALLEY, CA 92553-5441
(951) 242-8155
(951) 242-8311
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A52193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00521930
—
CA
01
—
W19646
MEDICARE ID:
CA
Enumeration date
12/14/2016
Last updated
12/14/2016
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