Provider Demographics
NPI:1003011479
Name:LOS ANGELES MEDICAL HEALTH CLINIC
Entity Type:Organization
Organization Name:LOS ANGELES MEDICAL HEALTH CLINIC
Other - Org Name:LOS ANGELES MEDICAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-721-6626
Mailing Address - Street 1:1400 CALLE SAN RAFAEL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2693
Mailing Address - Country:US
Mailing Address - Phone:787-721-6626
Mailing Address - Fax:787-725-1287
Practice Address - Street 1:1400 CALLE SAN RAFAEL
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2693
Practice Address - Country:US
Practice Address - Phone:787-721-6626
Practice Address - Fax:787-725-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1820103TC0700X
PR0070103TC0700X
PR011058207Q00000X
PR9251207R00000X
PR4847207RC0000X
PR8908207RP1001X
PR010561207V00000X
PR15909208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty