Healthcare Provider Details

I. General information

NPI: 1528101029
Provider Name (Legal Business Name): CLINICA POPULAR MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 W. 7TH ST
LOS ANGELES CA
90057-3904
US

IV. Provider business mailing address

2410 W. 7TH ST
LOAS ANGELES CA
90057-3904
US

V. Phone/Fax

Practice location:
  • Phone: 213-381-7175
  • Fax: 213-381-7028
Mailing address:
  • Phone: 213-381-7175
  • Fax: 213-381-7028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number207QA35536D
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207RA35536D
License Number StateCA

VIII. Authorized Official

Name: DANIEL BERDAKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 213-381-7175