Healthcare Provider Details

I. General information

NPI: 1063863561
Provider Name (Legal Business Name): BUENA SALUD MEDICAL CLINIC,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S ATLANTIC BLVD SUITE 101
LOS ANGELES CA
90022-1754
US

IV. Provider business mailing address

212 S ATLANTIC BLVD SUITE 101
LOS ANGELES CA
90022-1754
US

V. Phone/Fax

Practice location:
  • Phone: 323-597-0053
  • Fax: 323-597-0078
Mailing address:
  • Phone: 323-597-0053
  • Fax: 323-597-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAGRIMAS HARO
Title or Position: CEO
Credential:
Phone: 323-597-0053