Healthcare Provider Details

I. General information

NPI: 1629903356
Provider Name (Legal Business Name): ALMA HISPANA MEDICAL CLINIC MEDICAL PROFESSIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 E IMPERIAL HWY
LYNWOOD CA
90262-2653
US

IV. Provider business mailing address

3636 E IMPERIAL HWY
LYNWOOD CA
90262-2653
US

V. Phone/Fax

Practice location:
  • Phone: 310-455-6491
  • Fax:
Mailing address:
  • Phone: 310-455-6491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GRISELDA BANUELOS
Title or Position: CEO
Credential: NP
Phone: 310-455-6491