MEDICARE: CLINICA MONSIGNOR OSCAR A. ROMERO

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1053047670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA MONSIGNOR OSCAR A. ROMERO

Provider Business Mailing Address
First Line	:	6330 VAN NUYS BLVD UNIT A
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2610
Country	:	US
Telephone Number	:	818-994-9822
Fax Number	:	818-994-9821

Provider Business Practice Location Address
First Line	:	6330 VAN NUYS BLVD UNIT A
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2610
Country	:	US
Telephone Number	:	818-994-9822
Fax Number	:	818-994-9821

Authorized Official
Title or Position	:	DIRECTOR OF COMPLIANCE
Name	:	ROMEO V HERRERA
Credential	:
Telephone Number	:	310-407-9331

Provider Enumeration Date	:	07/26/2022
Last Update Date	:	07/26/2022

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