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General NPI Number Information
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NPI Number | 1689779977
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Entity Type | Organization
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Legal Business Name | DEL PUEBLO MEDICAL CLINIC
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2721 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90031-2609
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Country | US
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Telephone | 323-223-0916
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Fax | 323-223-8411
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Provider Business Mailing Address
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Address Line | 1505 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-4544
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Country | US
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Telephone | 213-387-8515
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Fax | 213-387-0797
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Authorized Official
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Title or Position | PARTNER
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Name | MR. RENE LOPEZ
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Credential |
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Telephone | 213-272-7186
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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 | A859840
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License Number State | CA
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