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General NPI Number Information
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NPI Number | 1265740930
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Entity Type | Organization
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Legal Business Name | LOS REYES CLINICA MEDICA, INC.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 6007 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-4401
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Country | US
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Telephone | 323-725-1144
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Fax | 323-583-0012
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Provider Business Mailing Address
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Address Line | 6007 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-4401
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Country | US
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Telephone | 323-725-1144
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Fax | 323-583-0012
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MYRA GOMEZ
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Credential |
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Telephone | 323-725-1144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology 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 | 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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