Healthcare Provider Details

I. General information

NPI: 1528553211
Provider Name (Legal Business Name): LA ESPERANZA MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5985 FLORENCE AVE STE O
BELL GARDENS CA
90201-6755
US

IV. Provider business mailing address

5985 FLORENCE AVE STE O
BELL GARDENS CA
90201-6755
US

V. Phone/Fax

Practice location:
  • Phone: 562-381-2235
  • Fax: 562-381-2902
Mailing address:
  • Phone: 562-381-2235
  • Fax: 562-381-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: ELVIRA P FLORES
Title or Position: SECRETARY
Credential: NP
Phone: 562-682-7683