Provider Demographics
NPI:1053047670
Name:CLINICA MONSIGNOR OSCAR A. ROMERO
Entity Type:Organization
Organization Name:CLINICA MONSIGNOR OSCAR A. ROMERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:V
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-407-9331
Mailing Address - Street 1:6330 VAN NUYS BLVD UNIT A
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2610
Mailing Address - Country:US
Mailing Address - Phone:818-994-9822
Mailing Address - Fax:818-994-9821
Practice Address - Street 1:6330 VAN NUYS BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2610
Practice Address - Country:US
Practice Address - Phone:818-994-9822
Practice Address - Fax:818-994-9821
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICA MONSIGNOR OSCAR A. ROMERO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)