Organization
CLINICA MEDICA SAN MARCOS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUSTAVO T. ROLDAN PA-C (MANAGER)
(323) 566-9171
Entity
Organization
Contact information
Practice address
3221 LIBERTY BLVD, SOUTH GATE, CA 90280-2315
(323) 566-9171
(323) 566-9178
Mailing address
3221 LIBERTY BLVD, SOUTH GATE, CA 90280-2315
(323) 566-9171
(323) 566-9178
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0711339
CA
Other
Enumeration date
01/28/2008
Last updated
01/10/2013
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