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General NPI Number Information
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NPI Number | 1699975557
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Entity Type | Organization
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Legal Business Name | SAN ANGEL MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 2661 E FLORENCE AVE SUUITE D-1
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4793
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Country | US
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Telephone | 323-588-6113
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Fax |
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Provider Business Mailing Address
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Address Line | 2661 E FLORENCE AVE SUUITE D-1
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4793
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Country | US
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Telephone | 323-588-6113
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | STEPHINE KRAMER
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Credential | M.D.
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Telephone | 323-588-6113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A44599
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A52088
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15560
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G86496
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License Number State | CA
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