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General NPI Number Information
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NPI Number | 1710160049
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Entity Type | Organization
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Legal Business Name | CLINICA DEL PUEBLO
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 01/29/2008
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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 | 661-845-2399
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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 | 661-845-2399
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Fax | 661-845-1791
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Authorized Official
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Title or Position | OWNER
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Name | EARLA E QUISIDO
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Credential | MD
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Telephone | 661-845-2399
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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 | A48100
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License Number State | CA
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