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General NPI Number Information
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NPI Number | 1821139205
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Entity Type | Organization
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Legal Business Name | SANTA ROSA DE LIMA MEDICAL CLINIC INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6915 SEVILLE AVE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4901
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Country | US
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Telephone | 323-588-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 SEVILLE AVENUE
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255
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Country | US
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Telephone | 323-588-9800
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Fax |
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Authorized Official
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Title or Position | PHYSYCIAN
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Name | EDWIN ZEVALLOS
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Credential |
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Telephone | 323-588-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A53394
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License Number State | CA
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