Healthcare Provider Details

I. General information

NPI: 1194289967
Provider Name (Legal Business Name): SAN MARTIN DE PORRES MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 TELEGRAPH RD
PICO RIVERA CA
90660-5424
US

IV. Provider business mailing address

7615 EASTERN AVE
BELL GARDENS CA
90201-4509
US

V. Phone/Fax

Practice location:
  • Phone: 562-654-6855
  • Fax:
Mailing address:
  • Phone: 562-927-1307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA S CHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-654-6855