La Providencia Ipa, Inc.

NPI #1760906507 in Baldwin Park, California

Provider Information

NPI Number: 1760906507
Entity Type: Organization
Organization Name: La Providencia Ipa, Inc.
Primary Specialty: Internal Medicine
Enumeration Date: Aug 2, 2017
Last Updated: Oct 26, 2017

Practice Location

Address: 14342 RAMONA BLVD
City: Baldwin Park
State: California
ZIP Code: 91706-3241
Phone: (562) 463-0172

Authorized Official

Name: SAMUEL WOSK
Title: SECRETARY
Phone: (562) 463-0172

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X
Internal Medicine	207R00000X	Primary

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