Provider Demographics
NPI:1437175528
Name:EL MONTE LATINO MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:EL MONTE LATINO MEDICAL GROUP INC.
Other - Org Name:EL MONTE CENTRO MEDICO FAMILIAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-401-3734
Mailing Address - Street 1:10012 GARVEY AVE
Mailing Address - Street 2:SUITES 5 & 6
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2083
Mailing Address - Country:US
Mailing Address - Phone:626-401-3734
Mailing Address - Fax:626-401-3627
Practice Address - Street 1:10012 GARVEY AVE
Practice Address - Street 2:SUITES 5 & 6
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2083
Practice Address - Country:US
Practice Address - Phone:626-401-3734
Practice Address - Fax:626-401-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18152Medicare ID - Type UnspecifiedGROUP NUMBER