Healthcare Provider Details

I. General information

NPI: 1982978557
Provider Name (Legal Business Name): SAMARITAN MEDICAL & REHABILIATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2012
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

IV. Provider business mailing address

506 S ALVARADO ST
LOS ANGELES CA
90057-2904
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-2570
  • Fax: 213-484-4158
Mailing address:
  • Phone: 213-484-2570
  • Fax: 213-484-4158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA40185
License Number StateCA

VIII. Authorized Official

Name: DR. LORENZO TIZON
Title or Position: DIRECTOR
Credential: MD
Phone: 213-484-2570