MEDICARE: CLINICA MEDICA TEOCALI DE BOYLE HEIGHTS, 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	207Q00000X	Family Medicine Physician	A42108	CA

General Provider Information

NPI Number	:	1811015076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA MEDICA TEOCALI DE BOYLE HEIGHTS, INC.

Provider Business Mailing Address
First Line	:	2935 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1528
Country	:	US
Telephone Number	:	323-264-4545
Fax Number	:	323-264-4500

Provider Business Practice Location Address
First Line	:	2935 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1528
Country	:	US
Telephone Number	:	323-264-4545
Fax Number	:	323-264-4500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARTURO VELAZQUEZ JR.
Credential	:	M.D.
Telephone Number	:	323-264-4545

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/22/2020

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