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NPI Code Detail

MEDICARE: ALMA HISPANA MEDICAL CLINIC MEDICAL PROFESSIONAL

MEDICARE: ALMA HISPANA MEDICAL CLINIC MEDICAL PROFESSIONAL
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1629903356
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALMA HISPANA MEDICAL CLINIC MEDICAL PROFESSIONAL
Provider Business Mailing Address
First Line : 3636 E IMPERIAL HWY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-2653
Country : US
Telephone Number : 310-455-6491
Fax Number :
Provider Business Practice Location Address
First Line : 3636 E IMPERIAL HWY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-2653
Country : US
Telephone Number : 310-455-6491
Fax Number :
Authorized Official
Title or Position : CEO
Name : GRISELDA BANUELOS
Credential : NP
Telephone Number : 323-360-4071
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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