# SAN BLAS MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SAN BLAS MEDICAL CLINIC
- **Other names:** Clinica Medica San Blas
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1982035069
- **Legal business name:** SAN BLAS MEDICAL CLINIC
- **Authorized official:** MR. JESUS MANUEL FRAUSTO SR. MD (PRESIDENT)
- **Authorized official phone:** (714) 220-2223

## Contact information

- **Practice address:** 7777 KATELLA AVENUE, STANTON, CA 90680
- **Practice address phone:** (714) 220-2223
- **Practice address fax:** (714) 220-2249
- **Mailing address:** 7777 KATELLA AVENUE, STANTON, CA 90680
- **Mailing address phone:** (714) 220-2223
- **Mailing address fax:** (714) 220-2249

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A-79043 | CA | Yes |

## Other

- **Enumeration date:** 11/27/2013
- **Last updated:** 11/27/2013