MEDICARE: SIN FRONTERAS HEALTH AND WELLNESS CENTER, INC, A PROFESSIONAL CORPORAT

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	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114560083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIN FRONTERAS HEALTH AND WELLNESS CENTER, INC, A PROFESSIONAL CORPORAT

Provider Business Mailing Address
First Line	:	6006 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4402
Country	:	US
Telephone Number	:	323-725-6292
Fax Number	:	323-725-6292

Provider Business Practice Location Address
First Line	:	6006 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4402
Country	:	US
Telephone Number	:	323-725-6292
Fax Number	:	323-725-6292

Authorized Official
Title or Position	:	CEO/ PRESIDENT
Name	:	RAUL LOPEZ
Credential	:	M.D
Telephone Number	:	323-725-6292

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	12/14/2020

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