Provider Demographics
NPI:1629513296
Name:CLINICA MSR. OSCAR A. ROMERO
Entity Type:Organization
Organization Name:CLINICA MSR. OSCAR A. ROMERO
Other - Org Name:
Other - Org Type:
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:MHA
Authorized Official - Phone:213-201-2737
Mailing Address - Street 1:2032 MARENGO ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1319
Mailing Address - Country:US
Mailing Address - Phone:213-989-7700
Mailing Address - Fax:213-989-7702
Practice Address - Street 1:2032 MARENGO ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1319
Practice Address - Country:US
Practice Address - Phone:213-989-7700
Practice Address - Fax:213-989-7702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY524113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316033533Medicaid