Provider Demographics
NPI:1174099782
Name:ALEGRIA FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:ALEGRIA FAMILY MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGWU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, DNP
Authorized Official - Phone:310-554-4870
Mailing Address - Street 1:1315 N BULLIS RD STE 6
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-1662
Mailing Address - Country:US
Mailing Address - Phone:310-554-4870
Mailing Address - Fax:310-554-4359
Practice Address - Street 1:1315 N BULLIS RD STE 6
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-1662
Practice Address - Country:US
Practice Address - Phone:310-554-4870
Practice Address - Fax:310-554-4359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A387920Medicaid