Provider Demographics
NPI:1932445921
Name:CLEOTILDE S JOSE MD INC
Entity Type:Organization
Organization Name:CLEOTILDE S JOSE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CLEOTILDE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-559-2046
Mailing Address - Street 1:9726 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2717
Mailing Address - Country:US
Mailing Address - Phone:310-559-2046
Mailing Address - Fax:310-559-1928
Practice Address - Street 1:9726 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2717
Practice Address - Country:US
Practice Address - Phone:310-559-2046
Practice Address - Fax:310-559-1928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24688261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty