Healthcare Provider Details

I. General information

NPI: 1225080864
Provider Name (Legal Business Name): HISPANIC PHYSICIAN IPA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 VALLEY BLVD. SUITE 100
EL MONTE CA
91731
US

IV. Provider business mailing address

PO BOX 255185
SACRAMENTO CA
95865-5185
US

V. Phone/Fax

Practice location:
  • Phone: 213-637-0925
  • Fax: 213-355-8731
Mailing address:
  • Phone: 213-596-7668
  • Fax: 213-355-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: YVETTE BROWN
Title or Position: CEO
Credential:
Phone: 213-521-5858