Organization Name: | CLINICA MEDICA SAN MARCOS INC |
NPI Number: | 1679773840 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GUSTAVO ROLDAN (SECRETARY) |
Mailing Address: | 3221 Liberty Blvd South Gate |
State: | CA US |
Postal Code: | 902802315 |
Phone Number: | 3235669171 |
Fax Number: | 3235669178 |
NPI Enumeration Date: | 07/24/2007 |
NPI Last Update Date: | 01/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |