# MISSION SAN JUAN MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023271830
- **Authorized official:** NOEL JR TORRES MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (323) 564-1100

## Contact information

- **Practice address:** 9914 SAN JUAN AVE, SOUTH GATE, CA 90280-6108
- **Practice address phone:** (323) 564-1100
- **Mailing address:** 9914 SAN JUAN AVE, SOUTH GATE, CA 90280-6108
- **Mailing address phone:** (323) 564-1100

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A93526 | CA | Yes |

## Other

- **Enumeration date:** 07/02/2008
- **Last updated:** 07/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A93526 | CA MEDICAL LICENSE | CA |