ANZA COMMUNITY MEDICAL CENTER NPI 1619000775

NPI Information

NPI: 1619000775
Provider Name: ANZA COMMUNITY MEDICAL CENTER
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 05D2078140

Address:
56480 HIGHWAY 371
ANZA, CA
ZIP 92539
Phone: (951) 694-8549
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ANZA COMMUNITY MEDICAL CENTER is a primary care clinic center in Anza, CA. ANZA COMMUNITY MEDICAL CENTER NPI is 1619000775. The provider is registered as an organization entity type.

The provider's business location address is:

56480 HIGHWAY 371
ANZA, CA
ZIP 92539
Phone: (951) 694-8549
Fax: (951) 694-0249

The provider's authorized official is Jonathan Yujung Yun .
The authorized official title is President and has the following contact phone number (951) 566-6778.

The CLIA number assigned to this NPI record is 05D2078140 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/14/2007 and was last updated on 7/8/2008.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	20A8759	CALIFORNIA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ02419Z	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	GROUP ID
2	020A87591	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA
3	00AX87590	MEDICAID	CALIFORNIA
4	H78016	MEDICARE UPIN	CALIFORNIA

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: 4/28/2024

NPI Synchronization or Removal

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