Healthcare Provider Details

I. General information

NPI: 1093490237
Provider Name (Legal Business Name): SANTO NINO MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/17/2023
Certification Date: 06/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 N EASTERN AVE
LOS ANGELES CA
90032-1934
US

IV. Provider business mailing address

3412 N EASTERN AVE
LOS ANGELES CA
90032-1934
US

V. Phone/Fax

Practice location:
  • Phone: 323-343-9900
  • Fax:
Mailing address:
  • Phone: 323-343-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEIL DAVID KATCHMAN
Title or Position: CEO
Credential: M.D.
Phone: 323-343-9900