Provider Demographics
NPI:1104504166
Name:ROSEMEAD MEDICAL CLINIC
Entity type:Organization
Organization Name:ROSEMEAD MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C, DNP
Authorized Official - Phone:626-571-5577
Mailing Address - Street 1:3318 DEL MAR AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2373
Mailing Address - Country:US
Mailing Address - Phone:626-571-5577
Mailing Address - Fax:626-571-7405
Practice Address - Street 1:3318 DEL MAR AVE STE 205
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2373
Practice Address - Country:US
Practice Address - Phone:626-571-5577
Practice Address - Fax:626-571-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty