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Organization
CLINICA MEDICA LATINA, INC
Active
Organization
CLINICA MEDICA LATINA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORENZO MOISES VAZQUEZ M.D. (CEO / OWNER)
(951) 601-6618
Entity
Organization
Contact information
Practice address
24805 ALESSANDRO BLVD STE 8, MORENO VALLEY, CA 92553-6101
(951) 601-6618
(951) 247-6218
Mailing address
24805 ALESSANDRO BLVD STE 8, MORENO VALLEY, CA 92553-6101
(951) 601-6618
(951) 247-6218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
.
.
—
01
—
A70384
PROFESSIONAL LICENSE
CA
Enumeration date
09/19/2018
Last updated
09/19/2018
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