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General NPI Number Information
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NPI Number | 1932208600
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Entity Type | Organization
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Legal Business Name | THE MISSION MEDICAL CLINIC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3045 E FLORENCE AVE
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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 | 323-587-7771
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Fax | 323-587-8310
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Provider Business Mailing Address
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Address Line | P.O. BOX 2397
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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 | 323-587-7771
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Fax | 323-587-8310
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Authorized Official
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Title or Position | OWNER
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Name | EDUARDO DI SARLI
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Credential | MD
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Telephone | 323-587-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | A36991
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License Number State | CA
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