Healthcare Provider Details

I. General information

NPI: 1053799254
Provider Name (Legal Business Name): SAMARITANA MEDICAL CLINIC 7TH STREET 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

2033 W 7TH ST STE 3
LOS ANGELES CA
90057-4074
US

IV. Provider business mailing address

2033 W 7TH ST STE 3
LOS ANGELES CA
90057-4074
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-2288
  • Fax: 213-484-2225
Mailing address:
  • Phone: 213-484-2288
  • Fax: 213-484-2225

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: PRESIDENT
Credential: M.D.
Phone: 213-484-2288