Provider Demographics
NPI:1861771875
Name:SDC MEDICAL CLINIC
Entity type:Organization
Organization Name:SDC MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:CARANDANG
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-839-9100
Mailing Address - Street 1:1523 E AMAR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1619
Mailing Address - Country:US
Mailing Address - Phone:626-839-9100
Mailing Address - Fax:626-839-9106
Practice Address - Street 1:1523 E AMAR RD
Practice Address - Street 2:SUITE C
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1619
Practice Address - Country:US
Practice Address - Phone:626-839-9100
Practice Address - Fax:626-839-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty