Provider Demographics
NPI:1346482601
Name:TOLUCA LAKE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:TOLUCA LAKE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1818-623-0104
Mailing Address - Street 1:10745 RIVERSIDE DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2371
Mailing Address - Country:US
Mailing Address - Phone:181-862-3010
Mailing Address - Fax:181-862-3893
Practice Address - Street 1:10745 RIVERSIDE DR
Practice Address - Street 2:SUITE E
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602-2371
Practice Address - Country:US
Practice Address - Phone:181-862-3010
Practice Address - Fax:181-862-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19055208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty