Provider Demographics
NPI:1356469381
Name:NORTH BROADWAY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:NORTH BROADWAY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:B
Authorized Official - Last Name:FUSCALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-221-1131
Mailing Address - Street 1:2926 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2601
Mailing Address - Country:US
Mailing Address - Phone:323-221-1131
Mailing Address - Fax:323-221-3197
Practice Address - Street 1:2926 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2601
Practice Address - Country:US
Practice Address - Phone:323-221-1131
Practice Address - Fax:323-221-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty