MEDICARE: LA CLINICA

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	174400000X	Specialist	C50959	CA
2	174400000X	Specialist	A33882	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811166846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CLINICA

Provider Business Mailing Address
First Line	:	1400 W MCFADDEN AVE STE 4
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3438
Country	:	US
Telephone Number	:	714-546-8200
Fax Number	:	714-546-8755

Provider Business Practice Location Address
First Line	:	1400 W MCFADDEN AVE STE 4
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-3438
Country	:	US
Telephone Number	:	714-546-8200
Fax Number	:	714-546-8755

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. EBRAHIM DUEL
Credential	:	M.D.
Telephone Number	:	714-547-6641

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	03/07/2023

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Directions to “LA CLINICA ” Practice Location

Language	Start Address	Practice Location

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