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General NPI Number Information
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NPI Number | 1033477443
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Entity Type | Organization
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Legal Business Name | CLINICA MSR. OSCAR A. ROMERO
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 2032 MARENGO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1319
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Country | US
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Telephone | 323-987-1419
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Fax |
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Provider Business Mailing Address
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Address Line | 2032 MARENGO ST
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City | LOS ANGELES
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State | CA
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Zip | 90033-1319
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Country | US
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Telephone | 323-987-1419
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALBERT PACHECO
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Credential |
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Telephone | 213-201-2745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 960001398
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License Number State | CA
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