Provider Demographics
NPI:1093367476
Name:LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:LOS ANGELES CLINICA MEDICA GENERAL MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-739-3282
Mailing Address - Street 1:2208 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4002
Mailing Address - Country:US
Mailing Address - Phone:213-739-3282
Mailing Address - Fax:213-384-3373
Practice Address - Street 1:11001 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2620
Practice Address - Country:US
Practice Address - Phone:626-443-4300
Practice Address - Fax:626-443-9646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL MONTE CLINICA MEDICA GENERAL MEDICAL CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-15
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty