MEDICARE: LOS PALOS MEDICAL ASSOCIATES, 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	207R00000X	Internal Medicine Physician		CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CP5072	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0590281	OTHER	CA	CLIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	LAB90281F	OTHER	CA	LAB PROVIDER NUMBER

General Provider Information

NPI Number	:	1457358756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOS PALOS MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1033 LOS PALOS DR
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3916
Country	:	US
Telephone Number	:	831-424-2866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 LOS PALOS DR
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93901-3916
Country	:	US
Telephone Number	:	831-424-2866
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MRS. JEANINE ELLINWOOD
Credential	:	M.D.
Telephone Number	:	831-424-2866

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/21/2022

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Practice Location Address:

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Directions to “LOS PALOS MEDICAL ASSOCIATES, INC ” Practice Location

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