Provider Demographics
NPI:1063863561
Name:BUENA SALUD MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:BUENA SALUD MEDICAL CLINIC,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAGRIMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-597-0053
Mailing Address - Street 1:212 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1754
Mailing Address - Country:US
Mailing Address - Phone:323-597-0053
Mailing Address - Fax:323-597-0078
Practice Address - Street 1:212 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1754
Practice Address - Country:US
Practice Address - Phone:323-597-0053
Practice Address - Fax:323-597-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center