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)	960000308	CA

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	:	1275629495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA MONSIGNOR OSCAR A ROMERO

Provider Business Mailing Address
First Line	:	123 S ALVARADO STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2201
Country	:	US
Telephone Number	:	213-989-7700
Fax Number	:	213-989-7702

Provider Business Practice Location Address
First Line	:	123 S ALVARADO STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2201
Country	:	US
Telephone Number	:	213-989-7700
Fax Number	:	213-989-7702

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SANDRA ROSSATO
Credential	:
Telephone Number	:	213-201-2737

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/29/2016

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