Healthcare Provider Details

I. General information

NPI: 1962139568
Provider Name (Legal Business Name): CLINICA MEDICA SAN JUDAS TADEO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E FLORENCE AVE
HUNTINGTON PARK CA
90255-4708
US

IV. Provider business mailing address

2680 E FLORENCE AVE
HUNTINGTON PARK CA
90255-4708
US

V. Phone/Fax

Practice location:
  • Phone: 424-800-2124
  • Fax:
Mailing address:
  • Phone: 424-800-2124
  • Fax: 424-800-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ODILIA WALSH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 562-706-2433