MEDICARE: CLINICA MEDICA LA SAGRADA FAMILIA A PROFESSIONAL MEDICAL CORP

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	A48853	CA
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578567038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA MEDICA LA SAGRADA FAMILIA A PROFESSIONAL MEDICAL CORP

Provider Business Mailing Address
First Line	:	15955 PARAMOUNT BLVD
Second Line	:	UNIT A
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5144
Country	:	US
Telephone Number	:	562-531-9806
Fax Number	:	562-531-1394

Provider Business Practice Location Address
First Line	:	15955 PARAMOUNT BLVD
Second Line	:	UNIT A
City	:	PARAMOUNT
State	:	CA
Zip	:	90723-5144
Country	:	US
Telephone Number	:	562-531-9806
Fax Number	:	562-531-1394

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. MARVIN CANLAS TRANI
Credential	:	DO
Telephone Number	:	562-531-9806

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	06/27/2022

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