Healthcare Provider Details

I. General information

NPI: 1861771875
Provider Name (Legal Business Name): SDC MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 E AMAR RD SUITE C
WEST COVINA CA
91792-1619
US

IV. Provider business mailing address

1523 E AMAR RD SUITE C
WEST COVINA CA
91792-1619
US

V. Phone/Fax

Practice location:
  • Phone: 626-839-9100
  • Fax: 626-839-9106
Mailing address:
  • Phone: 626-839-9100
  • Fax: 626-839-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: LINA CARANDANG DELA CRUZ
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 626-839-9100