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Organization

SUPERIOR CARE MEDICAL CENER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. PATRICIA MACIAS (PRACTICE MANAGER)
(310) 225-3640
Entity
Organization

Contact information

Practice address
15401 S MAIN ST, GARDENA, CA 90248-2214
(310) 225-3640
(310) 225-3644
Mailing address
15401 S MAIN ST, GARDENA, CA 90248-2214
(310) 225-3640
(310) 225-3644

Taxonomy

Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
A22315
CA
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
A22315
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0
WORKERS COMP / PRIVATE CARE
Enumeration date
04/28/2014
Last updated
04/28/2014
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