Organization
DEL PUEBLO MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RENE LOPEZ (PARTNER)
(213) 272-7186
Entity
Organization
Contact information
Practice address
2721 N BROADWAY, LOS ANGELES, CA 90031-2609
(323) 223-0916
(323) 223-8411
Mailing address
1505 S VERMONT AVE, LOS ANGELES, CA 90006-4544
(213) 387-8515
(213) 387-0797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A859840
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A859840
—
CA
Enumeration date
09/13/2006
Last updated
08/22/2020
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