Healthcare Provider Details

I. General information

NPI: 1952197923
Provider Name (Legal Business Name): CLINICA MEDICA SAN LORENZO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 ROSECRANS AVE
PARAMOUNT CA
90723-3644
US

IV. Provider business mailing address

1840 N HACIENDA BLVD STE 10
LA PUENTE CA
91744-1143
US

V. Phone/Fax

Practice location:
  • Phone: 562-602-8877
  • Fax: 562-602-8844
Mailing address:
  • Phone: 626-931-6618
  • Fax: 626-931-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LORENZO VAZQUEZ
Title or Position: CEO
Credential: MD
Phone: 626-422-5958