Provider Demographics
NPI:1811015076
Name:CLINICA MEDICA TEOCALI DE BOYLE HEIGHTS, INC.
Entity Type:Organization
Organization Name:CLINICA MEDICA TEOCALI DE BOYLE HEIGHTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:323-264-4545
Mailing Address - Street 1:2935 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1528
Mailing Address - Country:US
Mailing Address - Phone:323-264-4545
Mailing Address - Fax:323-264-4500
Practice Address - Street 1:2935 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1528
Practice Address - Country:US
Practice Address - Phone:323-264-4545
Practice Address - Fax:323-264-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty