MEDICARE: BUENA SALUD MEDICAL CLINIC,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1063863561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUENA SALUD MEDICAL CLINIC,INC

Provider Business Mailing Address
First Line	:	212 S ATLANTIC BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1754
Country	:	US
Telephone Number	:	323-597-0053
Fax Number	:	323-597-0078

Provider Business Practice Location Address
First Line	:	212 S ATLANTIC BLVD
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1754
Country	:	US
Telephone Number	:	323-597-0053
Fax Number	:	323-597-0078

Authorized Official
Title or Position	:	CEO
Name	:	MRS. LAGRIMAS HARO
Credential	:
Telephone Number	:	323-597-0053

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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