Healthcare Provider Details

I. General information

NPI: 1073194429
Provider Name (Legal Business Name): SAMARITANA MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 04/17/2021
Certification Date: 04/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14282 AMAR RD
LA PUENTE CA
91746-2162
US

IV. Provider business mailing address

510 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

V. Phone/Fax

Practice location:
  • Phone: 213-482-3600
  • Fax: 213-483-4555
Mailing address:
  • Phone: 213-483-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM A MARTINEZ
Title or Position: PRESIDENT
Credential: PHYSICIAN ASSISTANT
Phone: 213-483-3600