MEDICARE: PATAGONIA MEDICAL HEALTH & ACQUISITIONS

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1912547472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATAGONIA MEDICAL HEALTH & ACQUISITIONS

Provider Business Mailing Address
First Line	:	1531 LOMITA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2024
Country	:	US
Telephone Number	:	310-530-9325
Fax Number	:	310-530-9303

Provider Business Practice Location Address
First Line	:	1531 LOMITA BLVD
Second Line	:
City	:	HARBOR CITY
State	:	CA
Zip	:	90710-2024
Country	:	US
Telephone Number	:	310-530-9325
Fax Number	:	310-530-9303

Authorized Official
Title or Position	:	PROVIDER
Name	:	DR. DIEGO IVAN KRIGER
Credential	:	MD
Telephone Number	:	951-288-7191

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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