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General NPI Number Information
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NPI Number | 1104476217
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Entity Type | Organization
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Legal Business Name | SU SALUD MEDICAL GROUP INC
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Dates
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Enumeration Date | 09/19/2019
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 7418 STATE ST
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5928
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Country | US
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Telephone | 323-835-6298
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Fax | 323-835-6081
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Provider Business Mailing Address
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Address Line | 7418 STATE ST
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-5928
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Country | US
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Telephone | 323-835-6298
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Fax | 323-835-6081
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ABDEL N ABDELSAYED
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Credential | MD
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Telephone | 323-918-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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