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: 10/02/2026
Certification Date: 10/02/2026
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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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