Healthcare Provider Details

I. General information

NPI: 1053368530
Provider Name (Legal Business Name): EAST LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6125 WHITTIER BLVD
LOS ANGELES CA
90022-4503
US

IV. Provider business mailing address

PO BOX 10091
BEVERLY HILLS CA
90213-3091
US

V. Phone/Fax

Practice location:
  • Phone: 323-887-0000
  • Fax: 323-722-8716
Mailing address:
  • Phone: 213-637-2530
  • Fax: 213-384-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN CARLOS GARCIA
Title or Position: BUSINESS ACCOUNTS MANAGER
Credential:
Phone: 213-637-2530