Healthcare Provider Details

I. General information

NPI: 1366586992
Provider Name (Legal Business Name): USC FAMILY MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W LAS TUNAS DR
SAN GABRIEL CA
91776-1268
US

IV. Provider business mailing address

420 W LAS TUNAS DR
SAN GABRIEL CA
91776-1268
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-9500
  • Fax: 626-296-9505
Mailing address:
  • Phone: 626-296-9500
  • Fax: 626-296-9505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HEATHER PALADINE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 626-296-9500