1093367476 NPI number — LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093367476 NPI number — LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093367476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2208 W 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90057-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-739-3282
Provider Business Mailing Address Fax Number:
213-384-3373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11001 MAIN ST STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-443-4300
Provider Business Practice Location Address Fax Number:
626-443-9646
Provider Enumeration Date:
07/15/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CARRILLO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
213-739-3282

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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