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General NPI Number Information
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NPI Number | 1437644002
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Entity Type | Organization
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Legal Business Name | PLAZA FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 11161 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3007
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Country | US
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Telephone | 562-695-2250
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Fax | 562-695-1569
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Provider Business Mailing Address
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Address Line | 7800 FLORENCE AVE
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City | DOWNEY
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State | CA
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Zip | 90240-3728
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Country | US
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Telephone | 562-928-5700
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Fax | 562-928-5707
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Authorized Official
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Title or Position | CEO
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Name | RAMON C GONZALEZ
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Credential | PHYSICIAN ASSISTANT
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Telephone | 562-928-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A67059
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License Number State | CA
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