Healthcare Provider Details

I. General information

NPI: 1881973444
Provider Name (Legal Business Name): CAMINO NUEVO FAMILY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

IV. Provider business mailing address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9934
  • Fax: 213-484-9939
Mailing address:
  • Phone: 213-484-9934
  • Fax: 877-665-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: SONIA C SORTO
Title or Position: COO
Credential:
Phone: 213-493-3976