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Organization
SAN MARTIN DE PORRES MEDICAL CLINIC OF SOUTH GATE, INC
Active
Organization
SAN MARTIN DE PORRES MEDICAL CLINIC OF SOUTH GATE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANA CONSIGLIERI (SUPERVISOR)
(323) 564-4408
Entity
Organization
Contact information
Practice address
10001 CALIFORNIA AVE, SOUTH GATE, CA 90280-6005
(323) 564-4408
(323) 564-9641
Mailing address
10001 CALIFORNIA AVE, SOUTH GATE, CA 90280-6005
(323) 564-4408
(323) 564-9641
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0061920
—
CA
Enumeration date
11/06/2006
Last updated
10/06/2014
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