# SAN LUCAS MEDICAL CLINIC, INC

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

## Provider details

- **NPI number:** 1295156982
- **Authorized official:** DR. VITAL HINOJOSA M. D. (MEDICAL DIRECTOR & OWNER)
- **Authorized official phone:** (213) 989-1535

## Contact information

- **Practice address:** 13939 SAN ANTONIO DR, NORWALK, CA 90650-4036
- **Practice address phone:** (213) 989-1535
- **Practice address fax:** (888) 882-7876
- **Mailing address:** 13939 SAN ANTONIO DR, NORWALK, CA 90650-4036
- **Mailing address phone:** (213) 989-1535
- **Mailing address fax:** (888) 882-7876

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A37463 | CA | Yes |

## Other

- **Enumeration date:** 12/23/2013
- **Last updated:** 12/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1396874202 | — | CA |
| 01 | — | ED251A | MEDICARE PTAN | CA |