Healthcare Provider Details

I. General information

NPI: 1841232394
Provider Name (Legal Business Name): PICO RIVERA COMMUNITY MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 DURFEE AVE
PICO RIVERA CA
90660-2037
US

IV. Provider business mailing address

4705 DURFEE AVE
PICO RIVERA CA
90660-2037
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-0621
  • Fax: 562-695-0660
Mailing address:
  • Phone: 562-692-0621
  • Fax: 562-695-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CLAUDIA HERNANDEZ
Title or Position: OWNER/PARTNER
Credential: M.D.
Phone: 562-692-0621