Healthcare Provider Details

I. General information

NPI: 1093028896
Provider Name (Legal Business Name): SANTA MARIA CLINICA FAMILIAR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N HARBOR BLVD
LA HABRA CA
90631-4847
US

IV. Provider business mailing address

308 N HARBOR BLVD
LA HABRA CA
90631-4847
US

V. Phone/Fax

Practice location:
  • Phone: 562-266-3032
  • Fax: 562-266-3036
Mailing address:
  • Phone: 562-266-3032
  • Fax: 562-266-3036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA105315
License Number StateCA

VIII. Authorized Official

Name: DELIA RAMIREZ
Title or Position: PRESIDENT
Credential: PA
Phone: 562-266-3032