MEDICARE: SAMARITANA MEDICAL CLINIC,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	2047059	CA
2	207Q00000X	Family Medicine Physician	A75748	CA

General Provider Information

NPI Number	:	1073706289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITANA MEDICAL CLINIC,INC.

Provider Business Mailing Address
First Line	:	510 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2904
Country	:	US
Telephone Number	:	213-483-3600
Fax Number	:	213-483-4555

Provider Business Practice Location Address
First Line	:	510 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2904
Country	:	US
Telephone Number	:	213-483-3600
Fax Number	:	213-483-4555

Authorized Official
Title or Position	:	DIRECTOR
Name	:	RAYMUNDO ROMERO
Credential	:	MD
Telephone Number	:	323-264-7238

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	12/26/2017

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