MEDICARE: CAL CITY CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	G78625	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942578943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAL CITY CLINIC

Provider Business Mailing Address
First Line	:	41019 WOODSHIRE DR
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93551-5746
Country	:	US
Telephone Number	:	661-547-3906
Fax Number	:	661-622-4257

Provider Business Practice Location Address
First Line	:	9300 N LOOP BLVD STE A&B
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-2269
Country	:	US
Telephone Number	:	760-373-1256
Fax Number	:	760-373-1214

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ASHMEAD ALI
Credential	:	MD
Telephone Number	:	661-547-3906

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	01/06/2012

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1215136957 — DONALD T HARWICK P.A.
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Directions to “CAL CITY CLINIC ” Practice Location

Language	Start Address	Practice Location

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