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VINEYARD PEDIATRIC MEDICAL CLINIC A PROFESSIONAL CORPORATION NPI 1477726586


NPI Information

NPI: 1477726586
Provider Name: VINEYARD PEDIATRIC MEDICAL CLINIC A PROFESSIONAL CORPORATION
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 05D0909779

Address:
1850 S AZUSA AVE
SUITE 209
HACIENDA HTS, CA
ZIP 91745
Phone: (626) 810-8688
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VINEYARD PEDIATRIC MEDICAL CLINIC A PROFESSIONAL CORPORATION is a specialist in Hacienda Hts, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. VINEYARD PEDIATRIC MEDICAL CLINIC A PROFESSIONAL CORPORATION NPI is 1477726586. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1850 S AZUSA AVE
SUITE 209
HACIENDA HTS, CA
ZIP 91745-813
Phone: (626) 810-8688
Fax: (626) 810-8978

The provider's authorized official is Helen C Huang .
The authorized official title is Ceo/physician and has the following contact phone number (626) 810-8688.

The CLIA number assigned to this NPI record is 05D0909779 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/9/2008 and was last updated on 4/9/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistG69976CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100G699760MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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