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Organization
GUADALUPE MEDICAL GROUP
Active
Organization
GUADALUPE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TEODULO CRUZ BONZON LCSW (OPERATING PROVIDER)
(818) 846-4469
Entity
Organization
Contact information
Practice address
1711 W TEMPLE ST STE 5658, LOS ANGELES, CA 90026-7337
(323) 543-4535
Mailing address
4525 EAGLE ROCK BLVD, LOS ANGELES, CA 90041-3214
(818) 846-4469
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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