Healthcare Provider Details

I. General information

NPI: 1932208600
Provider Name (Legal Business Name): THE MISSION MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 E FLORENCE AVE
HUNTINGTON PARK CA
90255
US

IV. Provider business mailing address

P.O. BOX 2397
HUNTINGTON PARK CA
90255
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-7771
  • Fax: 323-587-8310
Mailing address:
  • Phone: 323-587-7771
  • Fax: 323-587-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA36991
License Number StateCA

VIII. Authorized Official

Name: EDUARDO DI SARLI
Title or Position: OWNER
Credential: MD
Phone: 323-587-7771