Healthcare Provider Details

I. General information

NPI: 1265740930
Provider Name (Legal Business Name): LOS REYES CLINICA MEDICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 SANTA ANA ST
SOUTH GATE CA
90280-2021
US

IV. Provider business mailing address

2715 SANTA ANA ST
SOUTH GATE CA
90280-2021
US

V. Phone/Fax

Practice location:
  • Phone: 323-583-0450
  • Fax: 323-583-0012
Mailing address:
  • Phone: 323-583-0450
  • Fax: 323-583-0012

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: MYRA GOMEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-583-0450