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General NPI Number Information
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NPI Number | 1114231354
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Entity Type | Organization
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Legal Business Name | SAN LUCAS MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 05/31/2013
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Provider Practice Location Address
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Address Line | 2010 WILSHIRE BLVD SUITE 2012
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City | LOS ANGELES
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State | CA
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Zip | 90057-3507
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Country | US
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Telephone | 213-989-1535
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Fax | 213-989-1843
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Provider Business Mailing Address
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Address Line | 2010 WILSHIRE BLVD SUITE 2012
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City | LOS ANGELES
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State | CA
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Zip | 90057-3507
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Country | US
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Telephone | 213-989-1535
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Fax | 213-989-1843
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VITAL HINOJOSA
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Credential | M.D.
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Telephone | 310-521-9725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A37463
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License Number State | CA
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