CAL CITY CLINIC - NPI NUMBER 1942578943

Summary

Provider Name: CAL CITY CLINIC

NPI Number: 1942578943

Clasification: Clinic/Center (261QR1300X)

Specialization: Rural Health

Address:
9300 N LOOP BLVD STE A&B
CALIFORNIA CITY, CA
ZIP 93505

Phone Number: (760) 373-1256



Detailed Information

CAL CITY CLINIC is a rural health clinic/center in California City, CA. The assigned NPI number for this provider is 1942578943 and is registered as an organization entity type.

The provider's business address is:

9300 N LOOP BLVD STE A&B
CALIFORNIA CITY, CA
ZIP 93505-269
Phone: (760) 373-1256
Fax: (760) 373-1214

The provider's authorized official is Ashmead Ali .
The authorized official title is Owner and has the following contact phone number (661) 547-3906.

The enumeration date for this NPI number is 12/5/2011 and was last updated on 1/6/2012.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1336433051 ASHMEAD ALI
Clinic/Center (Rural Health)
1649217431 CHUNG MEDICAL CORPORATION, INC
Clinic/Center (Rural Health)

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QR1300X Clinic/Center Rural Health G78625 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 553894 MEDICARE OSCAR/CERTIFICATION CA
2 G06444 MEDICARE UPIN
3 1093898454 MEDICAID CA
4 RHM18534G MEDICAID CA

NPI Record

No. Field Name Field Value
1 NPI 1942578943
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name CAL CITY CLINIC
5 Provider First Line Business Practice Location Address 9300 N LOOP BLVD STE A&B
6 Provider Business Practice Location Address City Name CALIFORNIA CITY
7 Provider Business Practice Location Address State Name CA
8 Provider Business Practice Location Address Postal Code 935052269
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 7603731256
11 Provider Business Practice Location Address Fax Number 7603731214
12 Provider Enumeration Date 12/5/2011
13 Last Update Date 1/6/2012
14 Authorized Official Last Name ALI
15 Authorized Official First Name ASHMEAD
16 Authorized Official Title or Position OWNER
17 Authorized Official Telephone Number 6615473906
18 Healthcare Provider Taxonomy Code 1 261QR1300X
19 Provider License Number 1 G78625
20 Provider License Number State Code 1 CA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 553894
23 Other Provider Identifier Type Code 1 06
24 Other Provider Identifier State 1 CA
25 Other Provider Identifier 2 G06444
26 Other Provider Identifier Type Code 2 02
27 Other Provider Identifier 3 1093898454
28 Other Provider Identifier Type Code 3 05
29 Other Provider Identifier State 3 CA
30 Other Provider Identifier 4 RHM18534G
31 Other Provider Identifier Type Code 4 05
32 Other Provider Identifier State 4 CA
33 Is Organization Subpart N
34 Authorized Official Name Prefix Text MR.
35 Authorized Official Credential Text MD

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.