Provider Demographics
NPI:1942586136
Name:LATINOCARE PARTNERS MEDICAL GROUP
Entity Type:Organization
Organization Name:LATINOCARE PARTNERS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-455-3675
Mailing Address - Street 1:4741 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1209
Mailing Address - Country:US
Mailing Address - Phone:323-455-3675
Mailing Address - Fax:
Practice Address - Street 1:1336 W WHITTIER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4601
Practice Address - Country:US
Practice Address - Phone:323-455-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty