Organization Name: | SAN BLAS MEDICAL CLINIC |
NPI Number: | 1982035069 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JESUS MANUEL FRAUSTO (PRESIDENT) |
Mailing Address: | 7777 Katella Avenue Stanton |
State: | CA US |
Postal Code: | 90680 |
Phone Number: | 7142202223 |
Fax Number: | 7142202249 |
NPI Enumeration Date: | 11/27/2013 |
NPI Last Update Date: | 11/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A-79043 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |