Provider Demographics
NPI:1861582033
Name:SAN JUAN MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:SAN JUAN MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMANY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-483-2500
Mailing Address - Street 1:971 W 7TH ST
Mailing Address - Street 2:SUITE # B
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6757
Mailing Address - Country:US
Mailing Address - Phone:805-483-2500
Mailing Address - Fax:805-483-2525
Practice Address - Street 1:971 W 7TH ST
Practice Address - Street 2:SUITE # B
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6757
Practice Address - Country:US
Practice Address - Phone:805-483-2500
Practice Address - Fax:805-483-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 52286261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center