Healthcare Provider Details

I. General information

NPI: 1699153809
Provider Name (Legal Business Name): SAMARITANA MEDICAL CLINIC DUARTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 HUNTINGTON DR
DUARTE CA
91010-2449
US

IV. Provider business mailing address

1034 HUNTINGTON DR
DUARTE CA
91010-2449
US

V. Phone/Fax

Practice location:
  • Phone: 626-256-3638
  • Fax: 626-256-4168
Mailing address:
  • Phone: 626-256-3638
  • Fax: 626-256-4168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMUNDO ROMERO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 626-256-3638