Provider Demographics
NPI:1154010379
Name:CLINICA MICHOACAN
Entity type:Organization
Organization Name:CLINICA MICHOACAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:SAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAQOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-558-0022
Mailing Address - Street 1:903 S BRISTOL ST STE J
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4983
Mailing Address - Country:US
Mailing Address - Phone:714-835-4552
Mailing Address - Fax:
Practice Address - Street 1:130 N FAIRVIEW ST STE E
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3472
Practice Address - Country:US
Practice Address - Phone:714-558-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care