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NPI Code Detail

MEDICARE: EAST LA PAZ FAMILY MEDICAL CLINIC, PC

MEDICARE: EAST LA PAZ FAMILY MEDICAL CLINIC, PC
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
1207Q00000XFamily Medicine PhysicianPA15296CA
2213E00000XPodiatristE4677CA
3207Q00000XFamily Medicine PhysicianG56407CA

General Provider Information

NPI Number : 1215359450
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST LA PAZ FAMILY MEDICAL CLINIC, PC
Provider Business Mailing Address
First Line : 3712 WHITTIER BLVD STE 1
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1733
Country : US
Telephone Number : 323-268-8347
Fax Number : 323-268-8368
Provider Business Practice Location Address
First Line : 3712 WHITTIER BLVD # 1
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-1733
Country : US
Telephone Number : 323-268-8347
Fax Number : 323-268-8368
Authorized Official
Title or Position : CEO
Name : MR. WILLIAM CHU
Credential : M.S. P.A.C
Telephone Number : 323-268-8347
Provider Enumeration Date : 01/07/2014
Last Update Date : 07/20/2016

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Practice Location Address:
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1902355647 — EAST LA PAZ FAMILY MEDICAL CLINIC PA
Practice Location Address:
3712 WHITTIER BLVD , SUITE 1
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90023-1733
Practice Phone: 323-268-8347
Practice Fax: 323-268-8368

Directions to “EAST LA PAZ FAMILY MEDICAL CLINIC, PC ” Practice Location

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