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General NPI Number Information
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NPI Number | 1134293038
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Entity Type | Organization
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Legal Business Name | DEL PUEBLO MEDICAL GROUP
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10200 MAIN ST
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City | LAMONT
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State | CA
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Zip | 93241-1700
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Country | US
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Telephone | 661-845-1788
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Fax | 661-845-1791
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Provider Business Mailing Address
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Address Line | 10200 MAIN ST
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City | LAMONT
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State | CA
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Zip | 93241-1700
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Country | US
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Telephone | 661-845-1788
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Fax | 661-845-1791
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | ANTONIO NAVARRO
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Credential |
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Telephone | 661-845-1788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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