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Organization
SAN LUCAS MEDICAL CLINIC, INC.
Active
Organization
SAN LUCAS MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITAL HINOJOSA M.D. (MEDICAL DIRECTOR)
(310) 521-9725
Entity
Organization
Contact information
Practice address
2010 WILSHIRE BLVD, SUITE 2012, LOS ANGELES, CA 90057-3507
(213) 989-1535
(213) 989-1843
Mailing address
2010 WILSHIRE BLVD, SUITE 2012, LOS ANGELES, CA 90057-3507
(213) 989-1535
(213) 989-1843
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A37463
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396874202
—
CA
01
—
ED251A
MEDICARE PTAN
CA
Enumeration date
07/29/2010
Last updated
05/31/2013
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