Healthcare Provider Details

I. General information

NPI: 1316033533
Provider Name (Legal Business Name): CLINICA MONSIGNOR OSCAR A ROMERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARENGO STREET
LOS ANGELES CA
90033-1319
US

IV. Provider business mailing address

123 S ALVARADO STREET
LOS ANGELES CA
90057-2201
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-7700
  • Fax: 323-221-4528
Mailing address:
  • Phone: 213-989-7700
  • Fax: 213-989-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number960001398
License Number StateCA

VIII. Authorized Official

Name: SANDRA ROSATTO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 213-201-2737