MEDICARE: CLINICA LA LUNA Y EL SOL MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G54090	CA

General Provider Information

NPI Number	:	1013086289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA LA LUNA Y EL SOL MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-594-7400
Fax Number	:	510-594-7402

Provider Business Practice Location Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-594-7400
Fax Number	:	510-594-7402

Authorized Official
Title or Position	:	CEO
Name	:	MS. DEBRA JOY TURNER
Credential	:	RN
Telephone Number	:	510-594-7400

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	11/08/2012

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