MEDICARE: ZACOALCO URGENT CARE 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	207Q00000X	Family Medicine Physician	G75144	CA

General Provider Information

NPI Number	:	1669620563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACOALCO URGENT CARE CENTER INC

Provider Business Mailing Address
First Line	:	7313 COMPTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-2531
Country	:	US
Telephone Number	:	323-588-1383
Fax Number	:	323-588-2339

Provider Business Practice Location Address
First Line	:	7313 COMPTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-2531
Country	:	US
Telephone Number	:	323-588-1383
Fax Number	:	323-588-2339

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SAUL DE LA ROSA
Credential	:	PAC
Telephone Number	:	323-588-1383

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	01/17/2018

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