Provider Demographics
NPI:1104924984
Name:HEALTHY CHOICES MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:HEALTHY CHOICES MEDICAL CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-281-0125
Mailing Address - Street 1:850 SOUTH ATLANTIC BLVD.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4730
Mailing Address - Country:US
Mailing Address - Phone:626-281-0125
Mailing Address - Fax:626-281-1526
Practice Address - Street 1:850 SOUTH ATLANTIC BLVD.
Practice Address - Street 2:SUITE 203
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4730
Practice Address - Country:US
Practice Address - Phone:626-281-0125
Practice Address - Fax:626-281-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18389Medicare ID - Type Unspecified