Provider Demographics
NPI:1710427596
Name:SALUD INTEGRAL MEDICAL CLINIC,INC
Entity Type:Organization
Organization Name:SALUD INTEGRAL MEDICAL CLINIC,INC
Other - Org Name:CLINICA INTEGRAL DE SALUD Y BELLEZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:ROSIE
Authorized Official - Last Name:ASCENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:CLEC,MACNA
Authorized Official - Phone:213-219-8054
Mailing Address - Street 1:11605 VALLEY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3069
Mailing Address - Country:US
Mailing Address - Phone:626-416-5475
Mailing Address - Fax:626-416-5492
Practice Address - Street 1:11605 VALLEY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3069
Practice Address - Country:US
Practice Address - Phone:626-416-5475
Practice Address - Fax:626-416-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26089208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87004Medicare UPIN