Provider Demographics
NPI:1932520962
Name:CENTRO MEDICO INDUSTRIAL LATINO
Entity Type:Organization
Organization Name:CENTRO MEDICO INDUSTRIAL LATINO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-262-0599
Mailing Address - Street 1:4055 E OLYMPIC BLVD
Mailing Address - Street 2:#207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-3345
Mailing Address - Country:US
Mailing Address - Phone:323-262-0599
Mailing Address - Fax:323-262-0699
Practice Address - Street 1:4055 E OLYMPIC BLVD
Practice Address - Street 2:#207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-3345
Practice Address - Country:US
Practice Address - Phone:323-262-0599
Practice Address - Fax:323-262-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10175261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care