Healthcare Provider Details

I. General information

NPI: 1912547472
Provider Name (Legal Business Name): PATAGONIA MEDICAL HEALTH & ACQUISITIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 LOMITA BLVD
HARBOR CITY CA
90710-2024
US

IV. Provider business mailing address

1531 LOMITA BLVD
HARBOR CITY CA
90710-2024
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-9325
  • Fax: 310-530-9303
Mailing address:
  • Phone: 310-530-9325
  • Fax: 310-530-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DIEGO IVAN KRIGER
Title or Position: PROVIDER
Credential: MD
Phone: 951-288-7191