# PICO CLINICA MEDICA LATINA, A MEDICAL GROUP, INC

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

## Provider details

- **NPI number:** 1740329101
- **Authorized official:** DR. TERESITA ALONZO ZARENO MD (VICE PRESIDENT)
- **Authorized official phone:** (213) 386-5252

## Contact information

- **Practice address:** 1600 W PICO BLVD, LOS ANGELES, CA 90015-2410
- **Practice address phone:** (213) 386-5252
- **Practice address fax:** (213) 386-5323
- **Mailing address:** 1600 W PICO BLVD, LOS ANGELES, CA 90015-2410
- **Mailing address phone:** (213) 386-5252
- **Mailing address fax:** (213) 386-5323

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A39524 | CA | — |
| 208D00000X | General Practice Physician | A40110 | CA | Yes |

## Other

- **Enumeration date:** 02/05/2007
- **Last updated:** 12/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0082120 | — | CA |