Provider Demographics
NPI:1073706289
Name:SAMARITANA MEDICAL CLINIC,INC.
Entity Type:Organization
Organization Name:SAMARITANA MEDICAL CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAYMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-7238
Mailing Address - Street 1:510 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2904
Mailing Address - Country:US
Mailing Address - Phone:213-483-3600
Mailing Address - Fax:213-483-4555
Practice Address - Street 1:510 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2904
Practice Address - Country:US
Practice Address - Phone:213-483-3600
Practice Address - Fax:213-483-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2047059207Q00000X
CAA75748207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty