Provider Demographics
NPI:1316199847
Name:CLINICA MONSIGNOR OSCAR A. ROMERO
Entity Type:Organization
Organization Name:CLINICA MONSIGNOR OSCAR A. ROMERO
Other - Org Name:CLINICA MSR OSCAR A ROMERO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSATO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:213-201-2737
Mailing Address - Street 1:123 S ALVARADO ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2201
Mailing Address - Country:US
Mailing Address - Phone:213-201-2749
Mailing Address - Fax:213-201-2600
Practice Address - Street 1:123 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2201
Practice Address - Country:US
Practice Address - Phone:213-201-2749
Practice Address - Fax:213-201-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY485513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316199847Medicaid
2117543OtherPK