Provider Demographics
NPI:1942218730
Name:JOSE DE GUZMAN CO TING MD INC
Entity Type:Organization
Organization Name:JOSE DE GUZMAN CO TING MD INC
Other - Org Name:ECHO PARK FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DE GUZMAN
Authorized Official - Last Name:CO TING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-250-7069
Mailing Address - Street 1:2140 CAMINO SAN RAFAEL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206
Mailing Address - Country:US
Mailing Address - Phone:818-952-4118
Mailing Address - Fax:
Practice Address - Street 1:1160 N LOGAN STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:213-250-7069
Practice Address - Fax:213-250-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38825208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388250OtherCHDP
CA00A388250Medicaid
A38825Medicare ID - Type Unspecified
CA00A388250Medicaid