MEDICARE: VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1871146878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY CLINICA MEDICA GENERAL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	6511 VAN NUYS BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-1425
Country	:	US
Telephone Number	:	818-901-9090
Fax Number	:	818-901-9347

Provider Business Practice Location Address
First Line	:	6347 PACIFIC BLVD
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-4101
Country	:	US
Telephone Number	:	323-583-8383
Fax Number	:	323-583-8399

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JUAN CARLOS GARCIA BACHMANN
Credential	:
Telephone Number	:	213-637-2530

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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