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General NPI Number Information
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NPI Number | 1295156982
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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 | 12/23/2013
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Last Update Date | 12/23/2013
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Provider Practice Location Address
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Address Line | 13939 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4036
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Country | US
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Telephone | 213-989-1535
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Fax | 888-882-7876
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Provider Business Mailing Address
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Address Line | 13939 SAN ANTONIO DR
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City | NORWALK
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State | CA
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Zip | 90650-4036
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Country | US
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Telephone | 213-989-1535
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Fax | 888-882-7876
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Authorized Official
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Title or Position | MEDICAL DIRECTOR & OWNER
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Name | DR. VITAL HINOJOSA
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Credential | M. D.
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Telephone | 213-989-1535
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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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