MEDICARE: EAST LOS ANGELES CLINICA MEDICA GENERAL 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1053368530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 10091
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-3091
Country	:	US
Telephone Number	:	213-637-2530
Fax Number	:	213-384-3373

Provider Business Practice Location Address
First Line	:	6125 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4503
Country	:	US
Telephone Number	:	323-887-0000
Fax Number	:	323-722-8716

Authorized Official
Title or Position	:	BUSINESS ACCOUNTS MANAGER
Name	:	MR. JUAN CARLOS GARCIA
Credential	:
Telephone Number	:	213-637-2530

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	12/23/2014

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