Healthcare Provider Details

I. General information

NPI: 1962459479
Provider Name (Legal Business Name): VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/26/2023
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8646 WOODMAN AVE
ARLETA CA
91331-6503
US

IV. Provider business mailing address

PO BOX 564
BEVERLY HILLS CA
90213-0564
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-9090
  • Fax: 818-901-9347
Mailing address:
  • Phone: 213-637-2530
  • Fax: 213-384-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSE L CARRILLO JR.
Title or Position: OFFICE MANAGER
Credential:
Phone: 213-739-3282