Organization
SAN LUCAS MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITAL HINOJOSA M.D. (MEDICAL DIRECTOR)
(310) 521-9725
Entity
Organization
Contact information
Practice address
2010 WILSHIRE BLVD, SUITE 2012, LOS ANGELES, CA 90057-3507
(213) 989-1535
(213) 989-1843
Mailing address
2010 WILSHIRE BLVD, SUITE 2012, LOS ANGELES, CA 90057-3507
(213) 989-1535
(213) 989-1843
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A37463
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396874202
—
CA
01
—
ED251A
MEDICARE PTAN
CA
Enumeration date
07/29/2010
Last updated
05/31/2013
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