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General NPI Number Information
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NPI Number | 1326133687
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Entity Type | Organization
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Legal Business Name | THE VIDAL WOMANS MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 11502 S. VERMONT AVE STE B
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City | LOS ANGELES
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State | CA
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Zip | 90044
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Country | US
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Telephone | 323-755-5500
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Fax | 323-755-5522
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Provider Business Mailing Address
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Address Line | 1601 N SEPULVEDA BLVD # 400
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5111
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Country | US
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Telephone | 323-755-5500
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Fax | 323-755-5522
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Authorized Official
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Title or Position | CEO, PRESIDENT
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Name | ISAIAS DE GUZMAN PAJA JR.
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Credential | MD
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Telephone | 323-755-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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