Provider Demographics
NPI:1356498935
Name:PARA LATINO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:PARA LATINO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAI
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-531-2231
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-0047
Mailing Address - Country:US
Mailing Address - Phone:562-531-2231
Mailing Address - Fax:562-531-8845
Practice Address - Street 1:15717 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-5113
Practice Address - Country:US
Practice Address - Phone:562-531-2231
Practice Address - Fax:532-531-8845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7325207Q00000X
CAG67118207V00000X
CAA52088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085780Medicaid
CAGR0085780Medicaid
CAG94775Medicare UPIN