Organization
SAN MIGUEL COMMUNITY CLINIC
Active
Parent organization
THE SAN MIGUEL FOUNDATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE SAN MIGUEL FOUNDATION
Authorized official
MR. KJ LAESSIG (EXECUTIVE DIRECTOR)
(213) 742-0255
Entity
Organization
Contact information
Practice address
825 N PARK AVE, POMONA, CA 91768-3002
(909) 622-9988
(909) 622-3452
Mailing address
825 N PARK AVE, POMONA, CA 91768-3002
(909) 622-9988
(909) 622-3452
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0016851
—
CA
Enumeration date
01/21/2013
Last updated
01/21/2013
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