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General NPI Number Information
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NPI Number | 1033529250
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Entity Type | Organization
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Legal Business Name | SUPERIOR CARE MEDICAL CENER
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 15401 S MAIN ST
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City | GARDENA
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State | CA
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Zip | 90248-2214
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Country | US
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Telephone | 310-225-3640
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Fax | 310-225-3644
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Provider Business Mailing Address
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Address Line | 15401 S MAIN ST
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City | GARDENA
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State | CA
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Zip | 90248-2214
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Country | US
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Telephone | 310-225-3640
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Fax | 310-225-3644
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. PATRICIA MACIAS
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Credential |
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Telephone | 310-225-3640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | A22315
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | A22315
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License Number State | CA
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