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General NPI Number Information
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NPI Number | 1144490996
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Entity Type | Organization
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Legal Business Name | CLINICA DE LATINOS, INC.
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 2362 N OXNARD BLVD SUITE 104
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City | OXNARD
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State | CA
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Zip | 93036-2047
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Country | US
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Telephone | 805-604-7500
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Fax | 805-604-7400
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Provider Business Mailing Address
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Address Line | 2362 N OXNARD BLVD SUITE 104
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City | OXNARD
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State | CA
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Zip | 93036-2047
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Country | US
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Telephone | 805-604-7500
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Fax | 805-604-7400
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Authorized Official
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Title or Position | CEO, CFO, MEDICAL DIRECTOR
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Name | DR. PHILLIP ADRIAN RUIZ
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Credential | M. D.
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Telephone | 323-359-9204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A44599
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License Number State | CA
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