Provider Demographics
NPI:1720186786
Name:GUADALUPE C. PEDRANO, M.D., INC.
Entity Type:Organization
Organization Name:GUADALUPE C. PEDRANO, M.D., INC.
Other - Org Name:SANTA MARIA FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUADALUPE
Authorized Official - Middle Name:CRUZ
Authorized Official - Last Name:PEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-226-0511
Mailing Address - Street 1:2209 N SAN FERNANDO RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1231
Mailing Address - Country:US
Mailing Address - Phone:323-226-0511
Mailing Address - Fax:323-221-5247
Practice Address - Street 1:2209 N SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1231
Practice Address - Country:US
Practice Address - Phone:323-226-0511
Practice Address - Fax:323-221-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40246261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center