| Organization Name: | SAN MARTIN DE PORRES MEDICAL CLINIC OF SOUTH GATE, INC |
| NPI Number: | 1134298318 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANA CONSIGLIERI (SUPERVISOR) |
| Mailing Address: | 10001 California Ave South Gate |
| State: | CA US |
| Postal Code: | 902806005 |
| Phone Number: | 3235644408 |
| Fax Number: | 3235649641 |
| NPI Enumeration Date: | 11/06/2006 |
| NPI Last Update Date: | 10/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |