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General NPI Number Information
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NPI Number | 1043462443
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Entity Type | Organization
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Legal Business Name | CLINICA FAMILIAR SAN LUCAS
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 11050 S ATLANTIC AVE
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City | LYNWOOD
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State | CA
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Zip | 90262-3068
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Country | US
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Telephone | 310-635-3800
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Fax | 310-635-0364
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Provider Business Mailing Address
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Address Line | 221 E GLENOAKS BLVD SUITE 130
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City | GLENDALE
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State | CA
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Zip | 91207-2085
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Country | US
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Telephone | 818-549-1713
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Fax | 818-549-1716
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BASIL FELAHY
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Credential | MD
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Telephone | 310-635-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A36908
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License Number State | CA
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