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General NPI Number Information
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NPI Number | 1801992565
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Entity Type | Organization
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Legal Business Name | SAN MIGUEL MEDICAL CLINIC, INC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8204 LONG BEACH BLVD SUITE B
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City | SOUTH GATE
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State | CA
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Zip | 90280-2011
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Country | US
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Telephone | 323-588-3300
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Fax | 323-588-0855
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Provider Business Mailing Address
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Address Line | 8204 LONG BEACH BLVD SUITE B
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City | SOUTH GATE
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State | CA
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Zip | 90280-2011
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Country | US
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Telephone | 323-588-3300
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Fax | 323-588-0855
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Authorized Official
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Title or Position | OWNER
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Name | DR. NAIM SALAMA
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Credential | MD
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Telephone | 323-588-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | FNP14677
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License Number State | CA
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