Organization
SAN MARTIN DE PORRES MEDICAL CLINIC OF SOUTH GATE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANA CONSIGLIERI (SUPERVISOR)
(323) 564-4408
Entity
Organization
Contact information
Practice address
10001 CALIFORNIA AVE, SOUTH GATE, CA 90280-6005
(323) 564-4408
(323) 564-9641
Mailing address
10001 CALIFORNIA AVE, SOUTH GATE, CA 90280-6005
(323) 564-4408
(323) 564-9641
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0061920
—
CA
Enumeration date
11/06/2006
Last updated
10/06/2014
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