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General NPI Number Information
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NPI Number | 1881616761
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Entity Type | Organization
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Legal Business Name | EAST LA PAZ MEDICAL CLINIC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 03/18/2014
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Provider Practice Location Address
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Address Line | 3712 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-1733
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Country | US
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Telephone | 323-268-8347
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Fax | 323-268-8368
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Provider Business Mailing Address
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Address Line | 3712 WHITTIER BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023
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Country | US
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Telephone | 323-268-8347
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Fax | 323-268-8368
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM CHU
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Credential | PAC
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Telephone | 323-268-8347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 15296
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G56407
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A23808
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | E 4677
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License Number State | CA
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