Healthcare Provider Details

I. General information

NPI: 1235033358
Provider Name (Legal Business Name): THE VIDAL WOMANS MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 S VERMONT AVE
LOS ANGELES CA
90006-4505
US

IV. Provider business mailing address

1601 N SEPULVEDA BLVD # 400
MANHATTAN BEACH CA
90266-5111
US

V. Phone/Fax

Practice location:
  • Phone: 323-755-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ISAIAS PAJA JR.
Title or Position: MD
Credential:
Phone: 323-755-5500