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General NPI Number Information
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NPI Number | 1467282194
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Entity Type | Organization
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Legal Business Name | CENTRO MEDICO COMMUNITY CLINIC, INC
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 502 W HOLT AVE
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City | POMONA
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State | CA
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Zip | 91768-3604
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Country | US
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Telephone | 951-278-8910
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Fax | 855-458-5492
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Provider Business Mailing Address
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Address Line | 1303 W 6TH ST STE 102
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City | CORONA
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State | CA
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Zip | 92882-3196
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Country | US
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Telephone | 951-278-8910
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Fax | 951-376-3097
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Authorized Official
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Title or Position | HR DIRECTOR
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Name | MS. SAMAR MASRI
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Credential |
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Telephone | 951-376-3097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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