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General NPI Number Information
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NPI Number | 1750944286
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Entity Type | Organization
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Legal Business Name | SAN DIMAS FAMILY CLINIC
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 04/19/2019
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Provider Practice Location Address
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Address Line | 150 W. FOOTHILL BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1102
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Country | US
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Telephone | 909-599-9921
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Fax | 909-592-3147
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Provider Business Mailing Address
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Address Line | 150 W. FOOTHILL BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-1102
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Country | US
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Telephone | 909-599-9921
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Fax | 909-592-3147
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Authorized Official
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Title or Position | OWNER
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Name | CLIFFORD SUSSMAN
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Credential | MD
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Telephone | 909-599-9921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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