Provider Demographics
NPI:1649855008
Name:SAMARITANA MEDICAL CLINIC, INC.-WASHINGTON
Entity type:Organization
Organization Name:SAMARITANA MEDICAL CLINIC, INC.-WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:213-500-5475
Mailing Address - Street 1:122 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3601
Mailing Address - Country:US
Mailing Address - Phone:213-483-3600
Mailing Address - Fax:213-483-4555
Practice Address - Street 1:122 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3601
Practice Address - Country:US
Practice Address - Phone:213-483-3600
Practice Address - Fax:213-483-4555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care