MEDICARE: EL MONTE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093762593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL MONTE CLINICA MEDICA GENERAL MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 2013
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-2013
Country	:	US
Telephone Number	:	213-637-2530
Fax Number	:	213-384-3373

Provider Business Practice Location Address
First Line	:	11001 MAIN ST STE 301
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2620
Country	:	US
Telephone Number	:	626-443-4300
Fax Number	:	626-433-9646

Authorized Official
Title or Position	:	BUSINESS ACCOUNTS MANAGER
Name	:	MR. JOSE LUIS CARRILLO JR.
Credential	:
Telephone Number	:	213-739-3282

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/19/2023

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