Healthcare Provider Details

I. General information

NPI: 1558524264
Provider Name (Legal Business Name): CLINICA MSR OSCAR A ROMERO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO ST STE 100
LOS ANGELES CA
90057-2356
US

IV. Provider business mailing address

123 S ALVARADO ST
LOS ANGELES CA
90057-2201
US

V. Phone/Fax

Practice location:
  • Phone: 213-989-7700
  • Fax: 213-201-8319
Mailing address:
  • Phone: 213-201-2737
  • Fax: 213-989-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550001341
License Number StateCA

VIII. Authorized Official

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