Healthcare Provider Details

I. General information

NPI: 1104219609
Provider Name (Legal Business Name): TOTAL CARE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 S VERMONT AVE
LOS ANGELES CA
90044-3112
US

IV. Provider business mailing address

10024 S VERMONT AVE
LOS ANGELES CA
90044
US

V. Phone/Fax

Practice location:
  • Phone: 323-756-1412
  • Fax: 323-756-1413
Mailing address:
  • Phone: 323-756-1412
  • Fax: 323-756-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. BLANCA VASQUEZ
Title or Position: ADMINISTRATOR
Credential: LVN
Phone: 323-756-1412