Healthcare Provider Details

I. General information

NPI: 1609701705
Provider Name (Legal Business Name): CC HUNTINGTON PARK MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 PACIFIC BLVD STE D
HUNTINGTON PARK CA
90255-4790
US

IV. Provider business mailing address

7130 PACIFIC BLVD STE D
HUNTINGTON PARK CA
90255-4790
US

V. Phone/Fax

Practice location:
  • Phone: 562-444-8422
  • Fax: 562-265-4775
Mailing address:
  • Phone: 562-444-8422
  • Fax: 562-265-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROGGIELYZ PADILLA
Title or Position: CEO
Credential: NP
Phone: 562-316-6555