Provider Demographics
NPI:1215359450
Name:EAST LA PAZ FAMILY MEDICAL CLINIC, PC
Entity Type:Organization
Organization Name:EAST LA PAZ FAMILY MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MS PAC
Authorized Official - Phone:323-268-8347
Mailing Address - Street 1:3712 WHITTIER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1733
Mailing Address - Country:US
Mailing Address - Phone:323-268-8347
Mailing Address - Fax:323-268-8368
Practice Address - Street 1:3712 WHITTIER BLVD # 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1733
Practice Address - Country:US
Practice Address - Phone:323-268-8347
Practice Address - Fax:323-268-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56407207Q00000X
CAPA15296207Q00000X
CAE4677213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598710600Medicare UPIN
CA1700811791Medicare UPIN
CA1699701581Medicare UPIN
CA1043227804Medicare UPIN