Organization
EASTSIDE DIABETES CARE MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALTAGRACIA A RODRIGUEZ (OFFICE MANAGER)
(323) 726-0370
Entity
Organization
Contact information
Practice address
5836 E BEVERLY BLVD, LOS ANGELES, CA 90022-2824
(323) 726-0370
(323) 726-0239
Mailing address
5836 E BEVERLY BLVD, LOS ANGELES, CA 90022-2824
(323) 726-0370
(323) 726-0239
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A33652
CA
261QH0100X
Health Service Clinic/Center
A33652
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A336520
—
CA
01
—
1972600880
NPI
—
Enumeration date
10/19/2010
Last updated
02/27/2015
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