MEDICARE: CENTRO MEDICO COMMUNITY CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1386298008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO MEDICO COMMUNITY CLINIC INC

Provider Business Mailing Address
First Line	:	1303 W 6TH ST STE 102
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-376-3097
Fax Number	:	951-376-3097

Provider Business Practice Location Address
First Line	:	1303 W 6TH ST STE 105
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92882-3196
Country	:	US
Telephone Number	:	951-278-8910
Fax Number	:

Authorized Official
Title or Position	:	HR/FINANCIAL COORDINATOR
Name	:	SAMAR MASRI
Credential	:
Telephone Number	:	951-278-8910

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	04/10/2026

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