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General NPI Number Information
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NPI Number | 1336464494
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Entity Type | Organization
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Legal Business Name | CLINICA MEDICA LA ESPERANZA
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 11/29/2010
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Provider Practice Location Address
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Address Line | 4207 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2835
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Country | US
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Telephone | 323-560-1100
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Fax | 323-560-1333
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Provider Business Mailing Address
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Address Line | 4207 SLAUSON AVE
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City | MAYWOOD
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State | CA
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Zip | 90270-2835
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Country | US
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Telephone | 323-560-1100
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Fax | 323-560-1333
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | REYNALDO QUINONEZ
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Credential | PA-C
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Telephone | 323-560-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A7810
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA17156
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19411
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 20A7810
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License Number State | CA
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