MEDICARE: CENTRO MEDICO INDUSTRIAL LATINO

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	261QP2300X	Primary Care Clinic/Center	20A10175	CA

General Provider Information

NPI Number	:	1932520962
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO MEDICO INDUSTRIAL LATINO

Provider Business Mailing Address
First Line	:	4055 E OLYMPIC BLVD
Second Line	:	#207
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3345
Country	:	US
Telephone Number	:	323-262-0599
Fax Number	:	323-262-0699

Provider Business Practice Location Address
First Line	:	4055 E OLYMPIC BLVD
Second Line	:	#207
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-3345
Country	:	US
Telephone Number	:	323-262-0599
Fax Number	:	323-262-0699

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. FRANCISCO RODRIGUEZ
Credential	:	D.O.
Telephone Number	:	323-262-0599

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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Directions to “CENTRO MEDICO INDUSTRIAL LATINO ” Practice Location

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