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General NPI Number Information
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NPI Number | 1760585129
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Entity Type | Organization
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Legal Business Name | COLIMA MEDICAL CLINIC PC
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 11/18/2010
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Provider Practice Location Address
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Address Line | 1850 S AZUSA AVE SUITE 205
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-964-2880
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Fax | 626-964-2834
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Provider Business Mailing Address
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Address Line | 1850 S AZUSA AVE SUITE 205
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City | HACIENDA HEIGHTS
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State | CA
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Zip | 91745
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Country | US
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Telephone | 626-964-2880
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Fax | 626-964-2834
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Authorized Official
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Title or Position | SECRETARY
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Name | MS. LIJI LIU
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Credential |
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Telephone | 626-964-2880
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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 | A37924
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A37925
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A67423
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License Number State | CA
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