| Organization Name: | SAN LUCAS MEDICAL CLINIC, INC. |
| NPI Number: | 1114231354 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VITAL HINOJOSA (MEDICAL DIRECTOR) |
| Mailing Address: | 2010 Wilshire Blvd Suite 2012 Los Angeles |
| State: | CA US |
| Postal Code: | 900573507 |
| Phone Number: | 2139891535 |
| Fax Number: | 2139891843 |
| NPI Enumeration Date: | 07/29/2010 |
| NPI Last Update Date: | 05/31/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A37463 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |